Pain Speak
Pain Speak
Voices in Pain - Prof Cormac Ryan
Welcome back to the new Season of the Pain Speak Podcast. This season is titled "Voices In Pain" and the focus of this season is to shine a spotlight on various organisations and people who are making a difference to pain management in the UK and beyond and helping patients in persistent pain. Some of the episodes will be a sole while others will have a guest joining me.
Join us for an insightful conversation with Cormac, the first guest for this new season of the Painspeak podcast. In this episode, Cormac shares his journey from aspiring vet to a leading figure in pain research and education. Discover how a pivotal book changed his perspective on physiotherapy and led him to champion the Flippin' Pain campaign. We delve into the importance of public health approaches to pain management and the impact of community involvement. Tune in to explore the challenges and triumphs of transforming pain education and the future of digital health initiatives.
Cormac Ryan is Professor of Clinical Rehabilitation at Teesside University and a community pain champion for the Flippin’ Pain campaign. He was awarded his PhD from the Glasgow Caledonian University in 2008 where he looked at the relationship between physical activity and persistent lower back pain. Cormac has published over 100 peer-reviewed journal articles and obtained over £1m in research funding. He enjoys fishing and long walks away from his children.
Flippin Pain is doing a free webinar Pain education for the nation on 15th October. It is part of EU pain awareness day and will feature Cormac along with a number of other speakers who are either patients with lived experience of pain or pain champions in their area.
So do register for it and share it . Pain Education for the Nation - Flippin' Pain
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The Pain Speak podcast is presented by Prof Deepak Ravindran, a NHS Consultant specialising in Pain and Lifestyle Medicine. Dr Ravindran is also the author of the book, 'The Pain Free Mindset'
Get in touch:
Twitter: @deepakravindra5
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Website: www.deepakravindran.co.uk
Linktree: https://linktr.ee/DrDeepakRavindran
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For Clinical Queries and consultations, please go to Berkshire Pain Clinic
Order a copy of the Pain Free Mindset here
For Season 1 and 3:
Mixed and edited by Rob Cao at https://dynamiqgroup.co.uk/
Huge Thanks to the The Podcast Coach at www.thepodcastcoach.co.uk
Welcome back to this new season of the Pain Speak Podcast. My name is Professor Dr. Deepak Robinson. I'm an honorary professor at Teastide University and a consultant in pain medicine and lifestyle medicine, working in primary care within the NHS in the UK. I've spent about 15 years in secondary care. I'm an author, a content creator, and this podcast new season, I'm going to be looking at a variety of topics that are related to pain. And we're going to start off with essentially the voices in pain people and organizations who are doing a lot for supporting people with persistent pain in the UK. And so I'm going to kick off this first episode of this season with a dear colleague and friend of mine, Professor Comak Ryan, who is going to be talking about more importantly his journey to where he is now, but also giving an introduction. This is a shout out to his event on October 15th, which is part of the European Pain Awareness Day, and he is doing it as a flipping pain champion, pain education for the nation. So do check it out in the show notes, there'll be details there. But Cormac joins me on this really insightful conversation, and he's going to share his journey from being an aspiring wet to a leading figure in pain research and education. You can discover how a pivotal book changed his perspective on physiotherapy and led him to champion the flippin' pain campaign, which he's been involved with for the last four to five years. We delve into the importance of public health approaches to pain management and why that is crucial and the impact of community involvement. I hope you can see how we can explore the challenges and triumphs of transforming pain education and the future of digital health initiatives. Cormac Ryan is the professor of clinical rehabilitation at Teesside University and a community pain champion for the Flip in Pain campaign. He was awarded his PhD from the Glasgow Caledonian University in 2008 where he looked at the relationship between physical activity and persistent lower back pain. Cormac has published over 100 peer-reviewed journal articles and obtained over 1 million pounds in research funding. He does enjoy fishing and long walks away from his children, as he says. So let's dive in. Hello, Cormac. Thank you so much for agreeing to be part of the Pain Speak Podcast new season. And uh you'll be the first guest on that I'll have in this season. So thank you so much for agreeing to be part of this, and welcome to the show.
SPEAKER_00:Thanks, D Pak. It's lovely to be here. It's lovely to be invited. Thanks so much for the invitation.
SPEAKER_01:Wonderful. Now um we we go back quite a long way, and and through flipping pain is when I came to meet you, know of you, and then we've collaborated uh for quite a number of years now. Um, primarily, what is it that drew you to pain research? What's been your journey that's brought you to where you are now?
SPEAKER_00:Uh yeah, well, that's it, that's a really interesting one. Um my journey, I guess, like so many others, uh, is not necessarily one that was perfectly planned out from the start. Uh, it took twists and turns. Um I think initially I I remember wanting to be a vet at one point, and then um, much to my father's who owns a farm, much to his dismay, I moved away from the idea of being a vet and and moved towards potentially being a physio, a physio or an archaeologist, both of which I I I loved the idea of. Um and then um I ended up doing sports science, uh and which I I have to say I thoroughly loved uh in the University of Limerick. Um, but I still wanted to be a physio at the end of it. Um, but it gave me a bit of a sort of I guess a passion for research. So I I I went into the um physio kind of with this nagging thing in the back of my mind, thinking research would be a nice career. I like the scientific elements of it, I liked doing like the dissertation modules with the bits I really enjoyed. Um, and it it it it was true also when I did the uh my MSc in physio. Um, and so I kind of came a crunch point. What do I want to do with my life? Actually, I really like this research, Malarkey. So I applied for a PhD, got a PhD uh uh at Glasgow Caledonian University straight just after finishing my my physio um masters, and uh it was in um back pain and physical activity. And um I thoroughly enjoyed it, and and like so many people in this pain education um world, a friend of mine gave me a book. Uh, her name is Margaret Grant, uh wonderful, wonderful person who I was doing my PhD with alongside at uh Glasgow Cali, and she gave me this book called Explain Pain. She said, That you'll love this book, really, really interesting. And up until that point, really, I had envisaged my career as people would walk in, I would crack their back, and they would leave, they would they would be instantly cured, I'd be a multimillionaire, and I'd also be doing some a lot of real good for people as well. Everyone's a winner. Um, and of course, I read this book and it it turned my my view on life and physio very much upside down. And I can remember I was reading it on a bus in Glasgow, I can remember the exact time, and it had quite a profound effect. And um ever since that I think my I found my career move more and more into persistent pain and pain education. Um, it drip feeded from that point, but it's I guess it's become a kind of more of a waterfall. Um yeah, and so that's that's kind of how I ended up in this game. Um, and uh it's uh it's been wonderful so far. Uh hopefully it'll be wonderful for the next 2 years until my mortgage paid off, then I'm out of it and I'm going fishing.
SPEAKER_01:Um I thought you're about to say retirement. Okay, so it's mortgage paid off then. Okay. It's about to give your age away out there on that point. Well, I often remember the the slide that you put in your talks where you you'd hoped that your profession would be the one that you'd be living in one of those really swanky mansions and and then you'd be dragging the slide of a boat and in the river there. That's that's live there. And I think pain education, obviously, right now you are you are a professor of clinical rehabilitation at Teaside University, but you're also in this unique place as a champion, a community champion for flipping pain, the organization. How do you balance all of this research, teaching, and this really public-facing work with flipping pain?
SPEAKER_00:Yeah, no, how how indeed, and I, you know, I'm sure I could easily bounce that exact same question back to you because I know you manage to do elements of everything, but there's probably one thing you do more of, and then other things you do smaller chunks of, and I guess that's the the case for for me. I'm predominantly a researcher, that's my day job, and it takes up most of my time. I do um teach teaching uh uh work with with undergraduate students and postgraduate students and a few PhD students. Um, I love teaching uh undergraduate healthcare professionals, physios, uh, OTs, chiropractors, etc. that really, really enjoy it. It's tremendous fun, and it's the best opportunity to help them to view pain differently. Uh uh, I think uh in our university years we're still quite malleable. I think after that we become a bit more set in our ways. So I I I I'm whenever I get the opportunity to do undergraduate-based lectures, etc. I always kind of take that if I can. And then I do still do clinical work as hard as that is uh to fit in, but I would say I see about 10 patients a year. That would be my guess. Um, I've got uh uh one patient at the moment um with some persistent knee pain. Um well actually no, I I take that back. I've got three patients at the moment. It's a bit of a it's a bit of a busy time for me, but um let's just say not all my patients are uh paying patients. I I I suffer from an inability to take people's money um um in in uh because we're also used to the NHS. We're also used to to to um that sort of uh you know giving care um and it not being about the money, um which of course it's not. I'm sure many healthcare professionals are in the same position. Um, but it's it's yeah, it's one of the things I struggle. I need to get better at it. I need to get better at so saying, can I please get paid for what I've done? But I um and it's not it's not that people wouldn't, I think it's just a case of uh some of the people like you know them. Do you know what I mean? You know them to fans of uh of uh um um friends and family and whatnot, and um it's just something about it doesn't feel right. There's an element of sort of neighborliness about. Um, and I I I uh you know it and I'm I'm sure you you'd be the same if your neighbor had a problem.
SPEAKER_01:You wouldn't I think that's something we all struggle with, isn't it? The the the balance between uh NHS private, where you just want to help out because they are known to you, you know them. Absolutely. That that's always I think uh now I it's interesting to say here you talk about the clinical practice. Obviously, mine is a more predominantly clinical role with very little uh research in that sense. What I do with you and then what I do in the University of Reading with a little bit of teaching annually, that those are my commitments, really. Um, but with flipping pain, that's a very unique space. You know, when I came to know you first as well, it was as this community champion for flipping pain. Both of us know Richard, who sort of is been the uh it's been his child to sort of start this whole thing off. How did you get to be involved in flipping pain? How did that whole thing work out? And and what does a community champion for flipping pain actually mean on a daily basis or on a weekly basis?
SPEAKER_00:So how I got into it um is that um Richard Pell, who who you you mentioned earlier on, who kind of started up Flip and Pain from within Connect Health, where now Cora is the is the name of the of the the organization. Um Richard had seen me present at um some other events. I did a I did a a pain education session in Newcastle, and it was to the to the public and two healthcare professionals, and uh he had come along and seen it. And um af afterwards, or I think in the in the in the sort of early time afterwards, he said, We're we're gonna set this thing up. It's you know it's uh it's a public health based set uh uh uh um campaign. And um I said, okay, well, I'm I'm I'm I'm interested. He said, Yeah, you have to come down and audition for it, which was really, really interesting because I'd never auditioned for anything. I had um you know interviewed for things and applied for posts and others, but I'd never never auditioned for anything. So that was really, really hot, but also really kind of interesting and new. And the idea was you went into the room and you had um five, ten minutes to uh present. I I think it was a fairly open-ended thing, something about pain education that you wanted to do. And there was a room of um people with lived experience, uh, healthcare professionals, and I think people from from uh Connect at the time as well. And um, I I I think several people went for it, I think, um, of various different um backgrounds from Lib Experience to healthcare professionals. I don't know if there were many other um sort of scientists, researcher types who applied for it. Um, but you know, I I did my thing. Clearly, they liked it and it and enjoyed it, and uh I was offered the role. Um, and um I said I'd only take it if I could do it as consultancy through the university. So, in other words, um the university essentially gets my the pay for me doing um releases the time and releases you as well. Absolutely, um, just because you know I've got a young family, I've got um um many other things going on, and the idea of an another another task to do, it just becomes unsustainable. Um, whereas actually making this part of my everyday work day, so this is part of my university work, is to contribute to the campaign, uh, to deliver sessions, to help develop content, um, and that just makes it achievable. Um, it's very much part of the research I do. Um once upon a time, uh research was very much in Ivory Towers. Um, it was the um it was the it belonged to the elite, it belonged to the those who lived in universities, had a certain level of education, um, etc. But I think huge efforts have been put into place to try and um break down those barriers, to um create a situation where education is uh attainable for everyone, and information and knowledge is attainable for everyone. Much of the information, knowledge that's derived has been derived through the use of public money. So it should be available to the public. Um and so there's a there's a within, certainly within the UK, there's a huge drive for public engagement work um and and a science communication that takes this scientific information that was developed with public money and make it available to that public. And and flip and pain for me is a the perfect vehicle to help do that. Uh so from a research perspective, I'm really, really lucky. Um, I I don't know about you, but I every day I I I feel extremely lucky for the things that have just fallen into my lap. Flip and pain is one of those things that just fell into my lap, and um I I'm extremely grateful for it.
SPEAKER_01:And I think uh, you know, not that I'm in any way biased in there, but I think that you being that champion is is really been one of the luckiest things that's happened to flip and pain, that's happened to at least pain science education as well in the UK. So, in that sense, it's a fantastic role model. And and every talk where I know you've given it there, the feedback I've always heard is that it's been one of the most fun ways to understand the new science, to listen about it. And and you, like Lorima Mosley out there in Australia, have made it so much more uh understandable to the public, to the public in general. And you know, I've been fortunate enough to be involved with you and with Richard and with the whole flippant pain team on a couple of the tours that you've done in the northern part of UK there. But the public health part there, you know, this approach to persistent pain using this public health model, we've all realized that pain, we talk about the biopsychosocial, we talk about moving away from biomedical. But we still have the challenge. Certainly in my clinical space, I still see patients on a daily basis who are stuck in the biomedical model, clinicians who have exactly, as you've said, the malleable plastic time as university, and once they come out into the general world, they still are very much stuck to the systems that incentivize a biomedical model. What do you feel when you took up the role as the community champion for flipping pain? Why do you think that the public health approach uh is so important? And and along the way, what are the challenges or limitations you you've uh found? And maybe one of the questions that lead up to this now is how many years at the time of us recording this in September 2025, how many years have you now been the pain champion for flip and pain? And what has been the advances but also the challenges?
SPEAKER_00:So it's been about six years since I've been involved in the flip and pain campaign. Um and um why is it important? Why is a public health approach important? I think it's about sort of bang for your book. Um I think um we simply don't have the resources that we need to reach each individual person with pain to um provide them with really really good information so that they can make more informed choices themselves. It has to be their choice, what they choose to do. Um you you you know we're all individuals with our own sort of paths to follow, and if someone wishes to follow uh an approach such as medications, such as surgeries, perhaps the things we'd we'd prefer people to move away from, um, we still have to respect that choice. If those are the choices that they choose and and wish to go down. But I think what we need to make sure is we give them all the information available and talk through it with them so that they understand those choices. And I think if they truly do, I think more and more will choose a more biopsychosocial approach, we'll choose a more evidence-based active physical and psychological therapies uh uh approach. But there's the um amount of people with that understanding, other healthcare professionals with that understanding, versus the amount of people with persistent pain that need uh the the the maths don't don't add up. It's an impossibility that we can provide that level of good quality information um to everyone who needs it. And not just those individuals with pain, but their immediate friends and family, because they will influence the thing. They're their their work colleagues, their their employer, their their healthcare professionals, all their entire ecosystem to use that famous buzzword. Um and um the only way I think to balance up that equation is to move to a sort of mass media, to move towards a public health platform where you can communicate to tens, hundreds, even thousands at a time. And you don't have to the you have to remember you're not delivering an intervention with this public health approach. So someone coming to one of our sessions, I wouldn't expect that you know the following day or six weeks down the line or a year down the line, that they'll necessarily be pain-free and and and and living a vastly different life. However, what I would hope is that for many who come, they will be nudged, nudged in a certain direction that makes them more curious about the pain and how it works and how their pain works, and more curious about um exploring other options than the ones that they had they've been given so far, and uh that are predominantly biomedical in nature, uh uh you know helping them to see that you know the there's there's a different path that they might want to want to try or explore. So you're really just as I say nudging beliefs and attitudes in a certain direction. Um but if you can do that for enough people, I liken it too. Do you know those uh um if you ever go to the pier at um at the beach where they've got the slot machines with the little two Ps, you know the little two P's that just hang out? If we can put in enough two Ps into those things that eventually you get that critical mass that just tips the the the uh uh a sort of a a windfall over and you you you you get your your p's in, it takes time. Um, but uh that that's what we're doing, and I think if if we could that's the the most achievable way, I think, with the limited resource we have to get the best information to as many people as possible.
SPEAKER_01:And and I think it's been a fantastic work, isn't it? In in six years, what do you feel with the research? Because you've said flippant pain has been something that you've been able to do within your work as the university prof with research and evaluation, and I've seen some of the data as well. But do you want to talk a little bit more about what the reach of uh of flippant pain has been, what the equity has been?
SPEAKER_00:Yeah, so uh it's what I think when you think about impact, so at a university level, uh impact is broken down into two things reach and significance. Uh in other words, if you reach a million people, but the impact you make is tiny tiny, um that's still a significant impact. Um, whereas if you reach 10 people, but you make an enormous difference to their lives, you know. You know, cure some extremely rare disease, for example. Um, that's a huge impact, even though it's only for 10 people. So it's it's it's that it's getting those two factors right. Uh, in an ideal world, you make a huge difference to lots and lots of people. Um in a program like this, something like Flip and Pain, the that's public health in nature, the idea is that you're going to be making for each individual human being a sm you want to be making a meaningful uh shift, even if it's small, but a meaningful shift on average, and then you want to be doing that to as many people as possible. So the last stats I um um saw from Flip and Pain suggested that I I think up to 300,000 people had been reached by the campaign. Um now, not all of those will necessarily have come to an event. Um that will be a combination of people who have perhaps engaged in some of our online uh materials like the flip and pain formula or engaged in the the brain bus or engaged in some other way, but about 300,000 people. Now, in terms of so that that's that that's that's the reach. Obviously, the vast, vast majority of those are in the UK, but you we can see from the online um um footprint that actually there's quite a a number of people from uh uh outside the UK have engaged as well. Um, so you've got that international element to it. Then um on top of that, when you look at the UK specifically, and again you look at the footprints of where we've been, where people have engaged from, etc. You see quite a uh a density of activity in areas that map to areas of social disadvantage in the UK. Which again is a really, really encouraging thing because as we know, persistent pain um is um disproportionately in affects and impacts on people from disadvantaged communities. So it is lovely to see that there is a uh um a tendency for our activities to be targeting and targeted towards uh more disadvantaged areas. Now I will I will uh sort of temper that and the fact that um that's kind of to some extent because we're running events in built-up suburban areas, and those suburban areas tend to be where you get that more disadvantage. So there's a you know it kind of happens by serendipity a little as well. Um but but but that's another nice aspect to what we've been doing in terms of of the the reach, and then in terms of impact, um we regularly uh evaluate our events in terms of um uh how people change their understanding of pain. Um and we usually use a qu a validated questionnaire called the pain beliefs questionnaire. Um we use that because it doesn't you don't have to have had pain have pain in order to fill it out. A lot of pain beliefs questionnaires you they ask you about how is your pain. Um so if you don't have pain, you it's difficult to fill out. And of course, we're a public health campaign. We're not, although we do tend to get quite a lot of people with pain at our events, we're not exclusively targeting people with pain. Exactly. We want the general public, some of whom will have pain and some of whom won't. Um, so we needed it to be something that doesn't you don't have to have pain, you don't have had to have pain from a certain area. Anyone can basically fill out this questionnaire and the the questions can make sense to them. Um but it's a way of kind of basically judging whether someone's got a very Biomedical view, hurt equals harm view of pain, or a more biopsychosocial view, more everything matters when it comes to pain type view. And we we've we've done this a lot, various different places, with different educators, different uh locations and situations, and consistently we see a drop in uh um biomedical-based beliefs, which is what we would want to see, uh a clear shift towards a more biopsychosocial understanding of pain. And by a meaningful amount, by a meaningful amount, it's very, very difficult to quantify what a meaningful amount is, but I tend to um um uh apply half a standard deviation uh uh as a way of judging what's a what's a what's a meaningful amount of a change, and we consistently see that level of change. Um and um so coming back to my my sort of equation of uh impact equals reach multiplied by significance, we've got 300,000 people, yeah, and we've got them changing on average their beliefs about pain by a meaningful amount. Um, and that to me is a good level of impact. That's a worthwhile level of impact uh um that I think is something that we should be very proud of, uh, and we should be telling as many people as as possible. Uh, running alongside that, we you also then have some really nice human stories. Yeah um because the numbers they only give you a certain uh uh uh viewpoint on it. But there are some wonderful stories if you go to the website of people um who have been impacted by uh uh the campaign. Really, really nice story uh from a lady down in Lincolnshire who uh after we we ran uh uh a series of events there, um, she emailed us about a year after coming to one of the events, and she just said, I wanted to drop you a note. Uh um I I was at two of your events last year, um they were they really, really sort of changed my view of how I was approaching my pain, and I wanted to let you know that this is the first day that I'm no longer on any opioids. I had been on opioids for many, many years. Um, I wasn't ready to try and come off the opioids at the time I saw you, but it kind of set me on that journey. And once I was ready, then I I I I sort of, with the help of my GP, began to come off. You know, so there's you know, whilst the average impact I talked about was was a kind of a small for some, for some, the level of impact has actually been quite huge. Um and those individuals do it themselves. Do you know what I mean? They put in the all the hard work, and they deserve all the accolades and all the the benefits and the positives and the the applaudits that come with it. However, there is a really nice warm feeling about the fact that perhaps it was our initial nudge, just gentle nudge in the right direction, that was was was a catalyst for that. So, in terms of the impact of the campaign, I think we've come a long way. I'm delighted with the impact we've made so far. I think we can make a really compelling case that it's been it's it's it's been a worthwhile endeavor, and I hope that if we if we make the same impact over the next five or six years, I've I think we'll be doing really well.
SPEAKER_01:Fantastic. Now, I think there's no doubt about that thing, half more than a quarter of a million reached. I don't think any clinician, as you said, with their one-to-one approach or trying to do it at their small scale, could have really hoped to impact so much, so many in that strength of time. And we've got to factor in the time that we had COVID, we had two, three years of very little movement outside, which is its own advantage because you might have been able to use the online space to reach out to more people, but it's still been a much more harder task in getting people to engage as well. So to have that kind of reach is brilliant. And that's another uniqueness of flip and pain that I've been able to see from up close and personal is the is that is the stories of recovery and hope that have emerged from there. But more importantly, flip and pain as a campaign and as opposed to many other events, which often can focus on the experts by profession. Flip and pain has chosen, I think, uh, very intentionally to spotlight patients right from the outset. I think so. That's something I've always noticed. Would you want to speak to that really on how that came? Was that always organically the intention that when you took on as community champion, patients would be involved center stage from day one? Or is that something that's been an iterative improvement as you've done the events over the years?
SPEAKER_00:I'd like to say it was all down to me, deep back. Um but you know, again, I'm I'm very lucky that I'm surrounded by really, really switched on uh um excellent people who who people like Richard, um Sam Feeling, uh Marvin uh Shepp. These are people you you would know, but the the listeners may not know, but these are members of the of the of the flip and pain team who uh uh um run the campaign on a day-to-day basis. And they I think were very clear that from the outset that if this was something that was driven purely by healthcare professionals and scientists, it would fall flat on its face. Um they were very quick to see um the value of lived experience in uh a campaign such as this. Um and so people with lived experience were reached out to at a very early stage, and I would say that at this at this point now we've we've we've I think in previous times when I've um been involved in research activities where there has been lived experience input. Um there's always been a them and us barrier, for want of a better word, not intentionally, but a sense of those people with lived experience were were helping us to do the work. Um and they were they were uh kind for want of a better word, others to the team. Uh but flip and pain, I think, is the first time when that's actually not been the case, and I I I think that some of that has simply been well, it's been loads of factors. First of all, the people who lived experience who who have come and engaged have been brilliant, extremely switched on, extremely knowledgeable, um uh and and committed. But it's also there's been like time. We've been together for five or six years, and so those barriers, as any barriers that exist between different groups as they come together, they slowly get broken down. So you get this sort of cohesive community. Um, so there I I would find myself now having chats, meetings, conversations with the lived experienced members of the team, and it's no longer the case that you're necessarily talking to someone uh from another. Yeah, um, it's like flip and pain team members who happen to be lived experienced people rather than perhaps lived experienced people who are contributing into the flip and pain campaign. If you see what I mean, yeah, it it's bit there's been this really nice overtime sense of community and um barriers broken down where um we're kind of like just a group of colleagues now rather than our little um um subsets of groups, and that has been that's one of the real strengths now where you can um I I think I feel comfortable leaning on those with lit the sort of lived experience speciality within the group, and I think they feel comfortable similarly leaning on me if and when they need to. Um and I you I think you can tell that from from the events and sessions we we now run. They're they're they are I think they're really sort of collegiate, and uh uh um there's a one of our our um people with lived experience uh is just about to start a PhD, and I don't think she would have done before this. I think it's just kind of uh everyone's roles are kind of blurring into one another, and and that I think that's when you get really meaningful collaboration and and work together. Um, and I think that's I think people who attend, I hope they see that, and I hope that it it it it it helps them to trust a bit more what we say, see the relevance of it, see the uh um be able to relate more to what the the the the campaign and group are saying. Um so yeah, that's a very long-winded answer to your question.
SPEAKER_01:No, I think it's something that we've all noticed and I've been witness as well as to how these lived experienced voices have gone on to then do so many really wonderful things and paid forward in a way which actually then, as a clinician, it's often made my role easier because I can tell a patient, look at this person, when we do understand pain, this is how we can change, this is how this person's life was, and this is how they've been transformed for the better. This is the work they have done, but this is the journey they've been on, and it's not impossible. Sometimes that learned helplessness or hopelessness that patients have when they go through a really long-winded pain journey before coming into my clinic, it's important to show them that hope. And I think flip and pain, with its stories of hope, with all the lived voices that are there, exactly does that. And in a way, that brings me to you know, this is one fantastic collaboration that's now, as you said, almost become part of the DNA of Flip and Pain. But I've also seen over the years that Flip and Pain has had its collaborations and partnerships with major organizations that work in this space. What are the other collaborations that you've had the opportunity to be part of? You know, other have other uh nations been involved with the flip and pain campaign? Have you been where else have you been able to take it at organizational level?
SPEAKER_00:So uh uh well, at organizational level from an international perspective, um there's we've been working with um um Limerick Sports Partnership down in the Republic of Ireland, uh, who are are looking to and have been looking to increase the knowledge and understanding and and of their um exercise professionals in the region. They um uh identified that the people in their region with pain were kind of reluctant to engage in the physical activity and exercise programs that were being laid out to the general public. Um and they kind of said, Well, you know, what if what could we do about that? Is there a way of upskilling um local health and fitness people um so that they're uh they are more comfortable working with people with with pain, and in a similar way, people with pain might be more comfortable working with them. Um, and so there's been a kind of a partnership with Flippin' Pain to try and uh change the mindset of the healthcare professionals, but also the chance to kind of reach out to the general public as well, and hopefully that more will come of that. Um, there's also been the opportunity to reach out to um other groups that are wanting to do something quite similar. So there's a group in um the Netherlands who have been looking to undertake their own public health type campaigns. So we've been able to kind of share with them the ideas and things that we've been doing so that they can kind of take it to their reinvent the wheel in a way, yeah. Yeah, absolutely, absolutely. So there have been some opportunities to to do it on an international level. Um more, I hope, will will follow. Yeah, uh uh over time.
SPEAKER_01:Um and I think nationally you've been involved with NHS Scotland. I think last year, or rather earlier this year, you've been at the British Pain Society, sort of the annual scientific meeting, which was in Wales as well, and then you've been to a number of uh uh places in the UK, including of course the tours in in Lincolnshire and and Teesside. So it it's a really widespread of how flippant pain has really influenced and in fact supported and recognized by various other organizations who are in this space, isn't it?
SPEAKER_00:Absolutely, absolutely. I I again because of being a uh primarily a researcher, um I I regularly get invited to deliver um sessions at conferences um, you know, certainly all over Europe. And um routinely I'm asked to come and present about the flip and pain campaign. That's what people want to hear. Uh it's really grasped the attention of many others in the the pain, chronic pain and public health space. Uh um so yeah, no, it it's uh it it's it's it's it's been something really well received internationally in that way.
SPEAKER_01:No, and I think certainly for all the listeners here, you should check out Cormac's talk in live if possible. The experiential feeling of him running up and down four floors is really a sight to behold and a and a fun activity to experience listening to the car alarm go off there. So I do hope a lot of you, a lot of the listeners will get the opportunity to see you live over the next few years there. You've got one very uh interesting event coming up in October, which is which is online for for right now. But do you want to tell us a bit more about this event? How will this be different or or what is it going to be focusing on?
SPEAKER_00:So there's this pain education for the nation, uh, which is happening on the 15th of October. Um, and it's um uh aligned with uh um um a sort of pain month and uh chronic pain month, and it's about the idea is that we're going to hire a venue, deliver uh a pain education to a bunch of individuals they are present in that venue, but the event will be live streamed to lots of other locations throughout throughout the UK.
SPEAKER_01:So it's gonna be hybrid then, fantastic.
SPEAKER_00:Absolutely, uh and um people can then operationalize it how they wish to do so in their their their communities and areas. So, for example, a a uh persistent pain service may well decide to to get up this uh sort of uh invite some of their patients to the screening of it, so then you'd have the the the the room open so that everyone could sit and watch it if they wished, and then have your own local panel. So after the event, you might have the clinicians there to to answer any questions people might have in the room. So it's kind of a you know how um the Shakespeare Company or Theatre Company, they will hold uh uh uh um they'll they'll do a show in the globe, but it will then be viewed or screened at the same time in at events throughout the the UK. Well, it's essentially that same idea.
SPEAKER_02:Okay.
SPEAKER_00:The uh event itself will be about two hours long. Um it will cover our main content, but it won't be our standard, standard presentation. For those of who have of your listeners who have been to one of our events, we have a kind of a standard, for want of a better word, show where we'll cover our our our six main key messages um and deliver that in a certain way. Um, and it's it's the Q ⁇ A sessions after, which always vary uh a lot more. Um and it that's morphed a bit over time, but it's been fairly, fairly um similar because we're we're constantly going out to different audiences, so the show's the same, but the audience is different. Um, however, this we are changing this a little by having a little bit more um lived experience um involvement. So our our our standard sessions is an introduction by someone with lived experience. Then I or another community pain champion will deliver a session of about 45 minutes to an hour, and then there'll be about a half an hour of QA from a panel of people with lived experience, healthcare professionals, and um whoever the speaker was. Um this time round, what we'll we're aiming to do is the 45 minutes to an hour session that would usually be one of the pain champions, such as myself. We're partitioning that so as, and in this case, it's gonna be me talking for about five minutes, and then it will be five minutes of a person with lived experience telling their story related to that key message. Then we move on to the next key message, so five or ten minutes from me, followed by five or ten minutes of key message from that person with lived experience, so it's much more um uh it integrated with the lived experience voice. Yeah, and it's I I think it's a bit more um storytelling-esque. Um now we try and have our presentations with a storytelling element to it, but um because stories are such a great way of conveying information. Um but I think by default, when you get the lived experience person's story involved in it, it really comes to light and uh comes to life and makes that story, gives that really lifts the storytelling within it. So I think it will be um perhaps uh just uh um I I will hopefully an even more engaging way of reaching out to to the audience members by having this sort of uh integrated approach for each message there, yeah.
SPEAKER_01:Maybe a good time now, actually. Say, do you want to give uh high-level sort of overview of what are the six key messages of the flipping pain campaign then?
SPEAKER_00:So, yeah, you know, you you don't need me for this, you know those six key messages as well as I do.
SPEAKER_01:Comes from the champion, it's going to be something awesome.
SPEAKER_00:So, but first of all, persistent pain is common and can affect anyone. Hurt does not always mean harm, everything matters when it comes to pain, medicines and surgeries are often not the answer. Understanding your pain can be key, and recovery is possible. And it's the those are the six key messages, and they've they in terms of where they've come from, um they they they they emigrated uh to a great extent from uh the pain revolution down in Australia and Larimer Mosley's group. Um, and there's a there's a wonderful publication by a lady called um um um Haley Leek, uh who uh in that publication it identifies what did people who um received a pain education-based care um for their pain and had a really good outcome. What were the messages that they valued the most? Yeah, and um three things bubbled up from from those publications from Haley, and that was um uh I'm paraphrasing them to to flip and paint, but hurt doesn't always mean harm was one of them. Everything matters when it comes to pain, and then um that feeling of hope, uh, that the idea of recovery is possible. Those three things seemed to be really, really pivotal to helping people to kind of transform their management and and uh and and uh um make much better uh sort of improvements in how they were managing their their pain. And so it it's you know, these although we have changed the wording slightly and adapted it for UK audience and all the rest of it, um it has those statements, they're evidence-based, um, but they're uh they're also comms-based in that you know they've been adjusted to kind of um help reach out to to as many people as as possible. Um so it it's that's where those those uh um six key messages have come from. We've tried to stick with them as much as possible because I think the more you stick with them, the more they become uh known um and and people can relate to them. Um it's interesting. The first one is potentially changing to um persistent pain is common and commonly misunderstood, uh, which I think is a really, really nice way of putting it. Um but yeah, otherwise the the key messages have been with us for for five or six years, and I think they're they're really, really important messages for for people to take on.
SPEAKER_01:Absolutely. And I I can attest to that in clinical practice itself. There is that understanding now where people are aware of these messages, it's definitely percolated down to many levels, and many clinicians are aware of these messages, or at least the elements there at a system level. You know, I think taking this research piece there and and implementing it, do you feel that there's been a shift in how systems can change? What are your thoughts and is your research now covering any of that piece of how the implementation can happen?
SPEAKER_00:I guess uh in terms of the systems change, I don't know if I'm I'm best placed to to to talk about that in its entirety, but I guess the the the the systems change that I think flip and pain works in is this idea of upstreaming and um um a move towards um prevention rather than uh um reactive treatment. Um and I think that you know that echoes something we've seen in the the um recent NHS 10 year plan. Yeah. Um and I think that's one of the really groovy things about the flipping pain campaign and pain revolution. Um it really does something that hasn't been done a great deal, which is look at persistent pain through a uh a preventative lens. Yeah, um, it's it is almost exclusively looked at through a reactive lens. Um and you know, this I don't there was a report by the Health Foundation which talked about you know how long-term conditions are going to become more common, and certain long-term conditions appeared that they may have become even more common than others. And chronic pain was top of that list, with a uh um it was expected to increase by more than any other long-term condition between now and 2040. And it didn't necessarily say why it believes that, uh, but it the that that was its projection. And when I reflect upon it, my thoughts are that um i it's because of the sort of lack of good information that's going out there on a public health level. So if we think about things like, for example, um obesity, yeah. Um if someone is struggling with their weight and um they're wanting to know what to do about it, well, there's gonna be loads of messaging out there about being a bit more physically active is is i i is a good way to to help with your weight and eating better. You know, it is gonna be Something that's good for your weight, your classic things like get your five a day, etc. Um, and so people might think, okay, well, that that helps me to make some more informed choices throughout my day that might help with my weight. Similarly, if they then feel like they need professional help, and they go and see a healthcare professional, that healthcare professional says, Well, you know, you really might want to think about becoming a bit more active and eating better. That person says, What good, that that it's funny you should say that because that that's things I've heard before, and that makes a degree of sense. You know, I can I I'm I'm I was kind of thinking that now that you've said it, that's that's increased my my uh enthusiasm and my uh given me a bit more resolve to try that. Um but when it comes to persistent pain, you have none of that. If someone is living with with with with with pain um in their uh everyday life, or even or with acute pain, they've they've got an episode of pain. There's there's there's no really good information out there on the public health sphere that's kind of saying you got pain, you know, be active, it's really good. It's an excellent way of of uh um uh managing your pain. So people are like, God, I don't I don't know what I should do. And that lack of good information uh uh um means that they may do the things that are most intuitive to do. And the most intuitive things to do are rest and avoid the pain. That's yeah, they take a medication, yeah. Yeah, they're they're they're unf unfortunately, though they're not the best things to do, they're they're they're they're what they're the a human thing that we we do. And then if you then think, Oh, I need to access a healthcare professional to help with this, and you go to the healthcare professional, if that healthcare professional then says, Oh, have you considered um being physically active or eating better, or any of the other things that we know can really help with persistent pain, yeah, um they're alien concepts. I think that the the because the person hasn't been drip fed those things before, and I know that drip feeding is something that you talk about a lot. Um so so they're and indeed, many they're just they're not necessarily not even receptive to it, but they may actually be quite um uh unhappy about hearing these things, feel like they're being dismissed or not heard or invalidated by these sorts of recommendations, and so it instead of going in prepared, primed, and being sort of more open to these sorts of messages, yeah, in fact that they're they're understandably maybe quite closed off because it they're hearing them for the first time, and they're very contrary to what they may have naturally felt they should be doing, and so it creates this uh circle of uh negativity and and and poor care, um, very different to the situation that that previous situation with with with obesity, for example. Um, and so uh again it comes back to the need, I think, to to change that around. It we need to I I think in the I I had a look for some data on this, it's very hard to find, but about one to three percent of um budgets in um areas like cardiovascular disease and diabetes are spent on public health approaches, right?
SPEAKER_01:Okay, so that's almost ring-fenced money that's there, which isn't there for pain as such.
SPEAKER_00:Absolutely, absolutely. Um, and you you just don't get that for uh um persistent pain, uh, you know, a similar a similar uh long-term condition. Um, you you've got both have that reactive care, but persistent pain does not have that proactive care. And I think that the lack of that, I think may explain why persistent pain as a condition is projected to increase more than other long-term conditions.
SPEAKER_01:That's a very good insight, Comak, and it might very well be right because that's one of the things which I'm aware of is what does getting it right first and the GERFT model for chronic pain, is hoping to actually explore all these variations that's happening across the UK, England specifically, and actually come up with one of the suggestions might very well be something that you've exactly alluded to. How do you correct for this variation where other long-term conditions do have a proactive element of funding and system alignment, which isn't there right now for chronic pain? Um, absolutely, thank you so much for that insight. I think that's really useful, even for me to reflect on, because it's I think it's up to us as clinicians as well to see what we can do in our own neck of the woods to change some of the narratives that are there. With your research, and as well, you know, and where you touched upon how this is going to be a major impact for the UK, uh, the numbers that you projected in 2040 as well, definitely the big talk is around return to work. And and just before we start recording, you did mention about where your research is leaning towards. How does uh probably there are two strands to this question? One is with the inevitable move of the NHS long-term plan, also talking about the digital option, what are the options for flipping pain in the digital and the AI age? You know, how is it going to be scaled into the digital option? Is it still going to be as intensive as you or another champion doing it? And then the second question leading up is is your research of flipping pain looking at this occupational health element?
SPEAKER_00:Yeah, yeah, yeah. No, uh really, really good question, Steepak. I think from an online perspective, so we've just uh um finished making a um uh an uh an online resource called Why We Hurt, and um that was very much co-produced with people with lived experience, so it's it's um uh hosted for want of a better word by myself and uh uh Libby Parfit, who's uh a person with lived experience of persistent pain, and um um that are you know really highly respected uh researchers like um Professor Larmer Mosley, uh there's some really excellent clinicians on it, and there's also uh a number of people with lived experience who whose journeys have been um really really compelling. You know, people who have been in um very, very dark places with their pain, um where this understanding of pain, not necessarily through the flippin' pain campaign, but they've they've they've accessed this information uh um through different sources, and it has really really turned the ship uh and and and changed their their lives for the better. And that combination of storytelling from those all those different uh um actors, uh uh uh uh for want of a better known as an actor. Obviously, we're all no no no means of training, but actors in terms of different contributors.
SPEAKER_01:Um with no auditions, mind you, yeah. No auditioning this one.
SPEAKER_00:No auditions for this one. That's what I mean. It was it's a really, really compelling piece of uh uh um educational uh uh um material, and that's available it's to access through the through the flip and pain team, but it it's uh it's not it's not available online at the moment. Um but the the um the idea or the principle is that it's been it's been designed in such a way as we want to it could be given to anyone, but people on waiting lists was who we were thinking about when we first developed it. Um so that if someone is on a waiting list to see a healthcare professional, they're gonna be on it for and you know it could be two weeks, it could be a year. That's just the world we live in at the moment. Um and that the longer people are on waiting lists, the the poorer their outcomes tend to be. Um and it's really wasted time. Um, but if we could get really good information to them soon, so they can be working on that, well, then for it it might mean that when they come in to see that healthcare professional, they're singing from that same hymn sheet, going back to this conversation. They may be more open to the active physical and psychological therapies that that healthcare professional is is offering and talking about. Um it just empowers that uh individual to start uh um um making better choices for themselves earlier, and that to such an extent that they may feel that they don't even necessarily need a healthcare professional. Maybe in a perfect world, I guess, uh it would be that effective. But I think for most people, it would just get them to start thinking about these things prior to their to their um um um health health appointment. Um so that's one way I guess that the campaign is embracing technology. But again, it goes back to this idea of resource and the fact that there's so few um people with with the right knowledge and skills and expertise uh um in comparison to the amount of need, and obviously putting it into a digital package makes it just more sustainable, more upscalable, can reach more people, and I think it's it's it's done in a I you know I I you know it's not necessarily down to me that it's done so well, but it is done well, it's down to the others on the team making it that that that that good. So I'm not uh uh bigging up myself here and being up the other people on that team who who really did far more work than I. And uh yeah, it's an excellent resource. I'm sure if anyone wanted to look at it more, they're they're welcome to get in contact and I can point them.
SPEAKER_01:Right now it's something that's available through the team, but it's not going to be available online to trial to the general public or to to the patient per se.
SPEAKER_00:As as I understand it, it's a tool that people can commission. So if there's a so if there's someone who who has uh let's say is in a works in an ICB and says, right, you know, that looks sounds like a really useful resource that we'd like to be made available to absolutely then I think what you what you do is you can contact the campaign and the campaign can issue you with licenses. There's only X many licenses. Uh I think there's a fee attached to the licenses, but I don't think the fee is exorbitant. I I think it's you know I think it's very, very affordable, as I understand it. Um and um yeah, I think it but it's it's it's a it's a way that we're embracing online um way of delivering the same information through.
SPEAKER_01:I think that's that's useful. Then at least it's it's again when it comes through, it's going to be a well-validated, useful resource that's been built on so much of legacy work that we know works at a population level. So and I think that I can understand that part there. What about the occupational health piece there? Is that something that can be then repurposed for the workforce, or is that a separate piece of research strand that you're doing?
SPEAKER_00:Um, so that's a separate piece of research we're doing. We've just gotten an NIHR grant through the Work and Health program to uh um explore the idea of taking um the campaign and adapting it for the workplace setting. Uh, and I think that's a really, really exciting opportunity. Um I think there's it's something that I I I I've when I was reading the work of um Gordon Waddle and Kim uh Burton Um and their you know is is work good for you good uh publication which they published now probably almost 20 years ago, and um similar work from from from Kim. Um you you get this sense of how important work is for good health and how detrimental um being out of work is for your health. Um and I think that that's a story that's really undertold. Um I think for the most part, if you look at the messages that people are given, it's that work is bad. Work is bad for your health, it it causes various health conditions, including chronic pain conditions. It's it's essentially the bad guy. And it is a a dangerous thing, it is a risk factor. Um when actually I think the the the literature I think tells a very, very different story. I think the literature says that actually being at work is super good for your health, um, and being out of work is not good for your health. I think the literature shows that uh the idea that work causes persistent pain just doesn't doesn't add up. The idea that it's causal is is is absolutely that's not to say that if you've got a persistent pain condition that it can't be aggravated by the working the work that you do and can't be annoyed by by that and make the work more difficult, absolutely. But the idea that the work is the cause of that pain, I think that's been hugely oversold and does not add up to scientific scrutiny. Yeah.
SPEAKER_01:Completely understand that I as you're saying that, Comac, one of the two of the thoughts that occurred to me, and maybe this is something that might be already part of your research space itself, is while that part is true, that the work in itself, you're right, has has got very tenuous links, I think the coexisting issue is the toxicity and all of the other workplace dynamics and culture of the workplace that could contribute to threat and safety perceptions. And and you know that might be a big factor in how pre-existing pain gets amplified or new onset persistent pain can come along. And I think that's that's one piece which which, as you mentioned, I feel that it may be a variable that could confound. And I think the other thing that I can already see as a as a big push, isn't it, when we go and take up work in any new workplace, we are subject to a variety of very musculoskeletal and body-bound advice of how we lift, how we do things. So trying to again come at it from the pain science world of how we provide those messages, it's going to feel almost a 180 degree of what messaging is right now being given, isn't it? That is that's going to be a big piece of belief that we'll have to again go about changing.
SPEAKER_00:Yeah, no, absolutely. Though the the those those workplace inductions, annual trainings, um that are a lot of them, I think, are very threat focused. You know, if you if you if you bend your back and carry in this way, that's the wrong thing to do. That will lead to injury. Uh though, you know, though those are the I think those are the messages that are being given. Um, you know, very overtly, some more inadvertently, like um pictures on the wall of people lifting something with big X's through them. Um it's it's it creates an expectation that work is bad for you and it's bad for your musculoskeletal health, and it's bad, it's going to cause pain. And I think human beings, as I I I know this is something that you've you've talked about a lot. We are prediction machines, and if we can if we create that expectation, it increases the likelihood it will happen. And so I think that's it's perfectly reasonable to make people aware of risk factors of something, um knowing that that will increase the risk of them developing that thing, if the evidence stacks up that that thing is truly a risk. However, if that thing is not truly a risk, or if the evidence is is limited that it is, and then we go and tell people that it's a risk, uh increasing the risk of that thing happening, I think we're we're we're simply uh lining people up for nocebo effects.
SPEAKER_02:Absolutely.
SPEAKER_00:Um and so we need to be much more um sort of uh sensitive to these issues and uh um give people clear and accurate information without fear-mongering. And I think a great deal of what we do in the occupational space at the moment is that, and I think a a lot of that is driven by um fear of things like litigation, etc., which which one can fully understand. Um, but I I think we we have to uh find ways of moving beyond it.
SPEAKER_01:Yeah. And is that what your grant is going to be looking at as work packages?
SPEAKER_00:So this is a preparatory grant to prepare for a a lot, so we're gonna do so a lot of patient public involvement and engagement work to explore the idea or potential of um um adapting the campaign for the workplace. Um and it will feed into a bigger grant application, and if a bigger grant application is successful, the idea will be to adapt, implement, and evaluate the campaign in a workplace. And we're likely going to target an NHS workplace. Um, because again, if you look at the the NHS 10-year plan, it highlights the importance of keeping our NHS staff fit and well. Um and uh so that's where we're going to target first, but um hopefully the findings will be uh um things we can transfer into other settings and other occupational spaces.
SPEAKER_01:Brilliant. Thank you, Comac, so much there. Well, that's been really fantastic uh work that you've been doing, and once again, so many thanks from me and from probably so many others that I know for the work you've done with Flippin' Pain. So, as we bring this conversation to a close there, um probably two things. What if if I could ask you to consider what one change you would like to see in all the people you interact with about understanding of pain in the next five years, what would that be?
SPEAKER_00:That's a really good question. Uh, and I I think uh it's probably about um believability. Uh I think um whenever you're communicating with someone about their pain or communicating with someone else about people with pain, um that idea of saying that all pain is real exists, or we believe it, uh and and and and we validate it, I think all everything needs to start from that platform. If you start from that very solid base, then I think you're on firm ground to begin to explore a person's belief systems and begin to shift them uh uh uh uh perhaps towards more evidence-based understanding of pain, uh, no matter what their context or or place. If you don't start from there, then I think you um set yourself up for miscommunication and uh uh um communication that actually is is uh uh um more harmful than helpful.
SPEAKER_01:Right. That's really fantastic. Thank you so much, Cormac, for this. Thank you for giving so much of your time today. Um, where can people find you? I know that you're not very often on social media, that much I know there, but where where can listeners find you and viewers find you if they want to know more or work with you or interact with you?
SPEAKER_00:Yeah, so absolutely I I have yet to engage with um social media. I think when I do engage with social media, that will be the the death knoll for social media. I I still remember the first time I started engaging with emails when I went to university for the first time, and I I famously said, I don't think these things will catch on. I think I I really had that, I was a visionary when it came online. Um one day I will embrace social media, and by the time I do, I'm sure there will be something else. Um, but for now, um the flip and pin campaign is where you'll where you're able to access most of the stuff that I do. Um, the flip and pain campaign is a really good website, it's got the flip and pin formula on it, which I'm a huge, huge fan of. Over 10,000 people have engaged with that uh to date. Uh, it's an excellent resource with lots of uh uh of podcasts, infographics, and animations where it talks through the information uh uh in a really, really um paced way. Um there's also uh um the uh um patient store or lived experience stories on it. It's a it's a really good website. Go there. Um, if you want to contact me, obviously you can contact me through Teaside University, uh uh where I'm um professor of clinical rehabilitation is my my sort of main title and and role there. Uh and you my email address, you can you can find it online, c. uh, Ryan at teas.ac.uk. And um yeah, those are the two places you'll tend to tend to find me.
SPEAKER_01:Absolutely. Well, thank you so much then. Once again, Comac. Have a wonderful day. Wish you all the very best for the October talk. It's pain education for the nation by flipping pain, isn't it? So keep a watch out. Do you have any location venues for where the screening things is that something that is dependent on people? That's the same thing. I should know. Yeah, but that's fine, we'll put that in the show notes, we'll have that all there in the notes there. But wish you all the best for that. And once again, thank you for coming on this episode this time around.
SPEAKER_00:Uh, thanks to you, D Pak. Thanks for all the the wonderful work you do promoting this stuff uh uh through your your your channel uh uh uh and all the other work you do. It's been a real honor and privilege to to speak with you.