Neil Pearson: Moving and Living Well is Possible in Pain

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About Neil Pearson

Neil Pearson is a physiotherapist and Clinical Assistant Professor at the University of British Columbia. He is an experienced yoga teacher, a yoga therapist, and creator of the Pain Care Yoga training programs for health professionals and yoga therapists. Neil is founding chair of the Physiotherapy Pain Science Division in Canada, recipient of the Canadian Pain Society’s Excellence in Interprofessional Pain Education award, faculty in yoga therapist training programs, and an author.

Neil develops innovative resources, collaborates in research, and serves as a mentor for health professionals and yoga practitioners seeking to enhance their therapeutic expertise. He is co-editor of ‘Yoga and Science in Pain Care: Treating the Person in Pain,’ available Aug 2019.

Neil Pearson is our resident pain teacher for our 300-hour YTT beginning April 10th, 2021, click here to apply to learn more about Strength, Science and Inclusion.

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Podcast Transcription

Kathryn Bruni-Young: This episode of the Mindful Strength Podcast is brought to you in partnership with Offering Tree. Offering Tree has set out to make digital marketing fun, easy, and most importantly for us yoga teachers, affordable. They are your one-stop-shop for your website, scheduling software, zoom integration, selling digital content like classes or courses, payment processing, email newsletter, and more. Stay tuned to hear more about them later in this episode. 

Kathryn: Hi Everyone. Welcome back. Today I am here with yoga teacher, yoga therapist, physiotherapist, researcher extraordinaire, Neil Pearson.

Neil Pearson is one of my absolute favorite teachers and people to talk to. I ask him all of my questions about pain and adaptation and movement practice. In today’s episode, Neil and I talk about pain science.

We talk about the biopsychosocial perspective. We talk about the way that pain comes up for different people. Whether it’s pain that comes up a few days after a practice or our training or if it’s pain that’s coming up immediately in the moment. Neal gives some really great tips on how we can start to discern whether or not the pain is alerting us to immediate danger. There’s just tons of great information in this episode.

If you’re interested in pain science, I highly recommend Neil’s work. I spent all last year mentoring with him and it was really just wonderful. Before we get into the podcast, I want to remind everyone about the Mindful Strength Membership, which is where Kyle and I teach our live classes. We also have a number of OnDemand classes. Every week we teach live. We record those classes while we’re teaching and those get uploaded.

Plus we upload other classes that are shorter, more around 20 to 30 minutes. You always have a number of options to choose from. Some classes have more of a yoga feel. Other classes are more about self-massage, restoration, winding things down. And then, of course, we’ve got workout classes. We have classes with weights and bands and blocks and blankets. You can use household items that you’ve got lying around and the classes are always fun and creative and a little bit different.

If you need a little bit more of that in your life, fun, creativity, and strength, you’re going to love it. If you want to get signed up, go to mindfulstrength.ca. Click memberships and you can take a tour. You can look around and see what we’ve got, watch some trailers, and then of course you can get signed up for your seven-day free trial. And within those first seven days, you can try everything out. If you’re not into it, you can just cancel before it charges your credit card. No big deal.

We offer technical support. If you get logged in and then you have any problems at all, you can just send us an email at support@mindfulstrength.ca and the wonderful Christopher Bourke will get back to you right away. He’ll help you figure it all out and get logged in so you can enjoy all of our classes. So again, if you want to sign up for the Mindful Strength Membership, give it a try, go over to mindfulstrength.ca and click memberships.

All right everyone, here is my conversation with Neil Pearson.

Kathryn: All right, Neil, welcome back to the podcast.

Neil Pearson: Thanks, Kathryn. Great to be here.

Kathryn: Yeah, I’m really looking forward to this. We have spoken many times since the last podcast recording, but the last time we actually recorded something for the show was before I did your mentorship program. And that feels like such a long time ago.

Although I’ve spent quite a while thinking about pain and asking you questions about pain, I feel like I always have more things to ask you. I’m really glad that we’re here again.

The first thing I want to ask is how do you describe to folks who maybe haven’t heard of this: the biopsychosocial model?

Neil Pearson: Wow, great question. I guess the first thing that I would start with is saying we need to question whether it’s actually a model or perspective because I think it really is much more of a perspective.

Models are often made to explain something. This is how it works. I guess the psychosocial could be sort of a model, but I think it’s much more of something that says this perspective is that we as humans, we are biopsychosocial, integrated to all those things together in the same place.

I can explain what it is not. A lot of people, when you talk about the biopsychosocial, they talk about its as if there’s the bio us or the biological, biomedical, or the biochemical us. Then there’s the part of us that’s the psyche. And then there’s the part of us that has to do with social things. And really, the intent of the term biopsychosocial is to say that we are integrated whole related to all of these three things.

Some people actually go beyond it to say we’re biopsychosocial-spiritual, to bring in the spiritual element as well. No matter how you talk about it, the idea is that they’re all woven together. That really matches up well, the perspective matches up well with perspective from yoga and the Pancha Maya Kosha perspective, that there are five aspects.

But really the idea there is that we are integrated of all five and that you can change any aspect of your existence through any other aspect of your existence, which is the same with biopsychosocial.

Kathryn: When you talk about this integration, does it also mean that we are biopsychosocial, all integrated all the time? Can you influence somebody’s bio alone?

Neil Pearson: I don’t think so. I think that’s if I use another example, something a little bit more concrete. Within us, we have the peripheral nervous system and the central nervous system, which is the spinal cord and brain, and we have the autonomic nervous system and talk about this through the enteric nervous system that is your gut.

Maybe I’ll just say with the peripheral, central, and automatic nervous system. We can talk about them as individual pieces. If you actually look at the anatomy of them, you can’t fully separate them from each other. They are integrated in the way that they are physically setup. And also, if you look at the physiology, there’s overlap between each of these systems.

If there’s input through the peripheral nervous system, there will be some change in the central nervous system. If there’s a change in the autonomic nervous system, there will be a change in the central nervous system. From a physiological point of view, it’s pretty hard to change one without changing the other.

The whole thing that is really fascinating about this is: it seems to be that the more we are stressed or the more we’re suffering, the more we’re in pain. It can be hard to change one aspect of self through another aspect of self. Once again, let me give you another example of that as to when. If I were to have somebody hooked up to a physiological biofeedback unit that was looking at skin conductance and heart rate variability, which are measurable physiological arousal. If someone’s in a really calm state, when they start to change their breath, you can see heart rate variability, heart rate, and skin conductance change quite quickly.

But when people start in place of a lot of stress, suffering, or pain, it’s like you need to work on calm breathing longer before you actually start to get the measurable changes or the change that you can see with the biofeedback machine.

Kathryn: OK, that’s interesting. Let me see if I can summarize that to see if I actually got it right. You’re hooked up to this machine. It’s measuring some things. And you said that when people are in a more calm state or not in a pain experience, then something like shifting their breath can change the metrics that this machine is measuring.

But when somebody is in that pain experience, did you say it takes more effort to calm things down?

Neil Pearson: Often it takes more time.

Kathryn: More time.

Neil Pearson: It seems that the more we are stressed or suffering or in pain, the harder it is to change one aspect of self through another aspect of self. I would say that’s an observation that I’ve seen. The more we’re in that state of calm, the easier it is to change your mind and then see the change in the body or to change the body and see the change in the mind. And the more you’re under stress, it’s like you have to do more of it to be able to get the change in the other aspect of yourself.

Kathryn: What do you think about the idea of good pain and bad pain? Oftentimes I hear someone say like, “well, you have to be able to know the difference between good pain and bad pain”. I’m wondering how you usually approach that idea.

Neil Pearson: It’s a great question because it’s something that people come up with a lot. I know there was one yoga author that actually had written this idea that everyone knows the difference between good pain and bad pain.

Of course, my reaction will be as well, no we don’t. That’s part of the reason why sometimes people get injured when we’re doing sport or exercise or yoga because we don’t know if this is a message to stop.

It’s really hard to come up with a really precise and really short answer. But I’ll do my best. I think that the more we become aware, the more we start to learn to pay attention to not just pain, but to other protective mechanisms within us or other interceptive sensations, the more likely we are to be able to come to a better differentiation of the sensation or this pain that I’m having is OK.

But when it’s like this, I know it’s not. Hopefully, that makes sense as a start. We then need to go to the idea is that pain by itself is not an accurate indication of whether something is truly dangerous to the tissues of the body. Pain is not an accurate indication of the health of our tissues. And so when we feel pain, the system is saying, “Hey, you know, maybe you should stop or change your behavior here”. But that’s not saying that you are damaged or close to damage.

It’s the system saying stop or change your behavior. It’s not accurate. When we move and we feel pain, the system is trying to get us to change our behavior. What we need to do is figure out is it OK to stay here? Because maybe the behavior we need to change is we could calm our breath or calm our body tension or calm our mind.

If you do that, it actually may change the amount of pain you have so you can actually stay longer, Maybe to say that in a different way is the more we practice awareness, the more we become more discerning about what is the right amount of effort, the right amount of pushing. The ok amount of pain while we’re exercising.

Kathryn: When you encourage people…they do a movement, they feel pain, and then it’s like, “OK, notice your body tension. What’s your breathing like? Do you think you’re going to regret this later?” You know, all of these great skills. Do you find at that moment, when people are going through this, becoming more discerning, a little exploration, do you find that sometimes people’s pain actually decreases like in that specific moment?

Neil Pearson: For sure, yeah. Some people find that just taking their awareness to the pain changes the pain. Other people find that they’ve got pain and then they calm their breath or they ask that question, is this really dangerous? And when you ask, is this really dangerous, you’re somewhat liberating your thoughts when you calm your breath, regulating your breath. And so sometimes when we regulate these things that actually change the pain, but sometimes the pain just changes when we actually approach what’s happening, we actually pay attention to it.

We work on awareness, which really comes around to tie this together to what we were saying before: we think that awareness and regulation and discernment are really important to help us know how hard we should push while we’re exercising or to help us know the answer to your question of how much pain is ok while we’re exercising.

Kathryn: Do you find that sometimes when people start to notice their pain more and become more aware of it and maybe put a little bit of a different type of attention on it, that the pain can intensify for some people?

Neil Pearson: Oh, absolutely. That’s what we need to be careful of. We seem to be in a place where people have decided that mindfulness is the answer for everything. Actually, paying attention is a panacea.

I think what we need to recognize is that there are times that we are taking your attention to something will actually make you hypervigilant in a very negative way. We’re taking attention to something that possibly the only way to cope is to psychically leave or disassociate. I think we need to recognize that there are adverse effects to everything that we provide people.

There’s a line from or a statement I’ve heard in the yoga world before is that “everything is medicine and everything’s poison”. But somehow we seem to get the idea of, “oh, no, this is always good”. There’s a psychology doctor her name is Willoughby Britton and she has a website cheetahhouse.org. It is actually is talking about the adverse effects of more contemplative practices, of the practices where you are increasing awareness and practice of meditation.

Kathryn: When people are doing movement and then they start to feel pain, you know, a lot of this work is about becoming more discerning and having this little explanation. When do you think is a really good time…what are the signs maybe that someone should stop what they’re doing?

Neil Pearson: I mean, there are some obvious ones. If you start to see changes of swelling in your body, that’s probably an indication that on that problem. That’s an indication that you’re pushing the tissue too hard. Swelling, heat, and redness, around joints, would be an indication it’s the wrong thing to do.

If the only way to continue the exercise is to suppress how you’re feeling or to suppress your thoughts or to suppress the pain or to disassociate, those things will be a clear indication that this is not the right thing to do as a recovery technique.

I think when you feel that you have no way of influencing how you’re breathing or no way of influencing your muscle tension, that’s one of those times when we need to start thinking like this is probably hard enough now. I’m probably pushing hard enough. If I really can’t slow my breath and change my breath or change my body tension, that’s when we sort of lose the ability to influence things in a positive way.

I think part of this question or the answer has to do with how do you do these things when you’re pushing hard?

Kathryn: Mmm-hmm.

Neil Pearson: And so it’s easier to figure out how to do it when you’re just being gentle. But I think for most people, what we start at the beginning is we sort of find this edge. We find the right place where we can go and we feel like at the spot we can find some influence over breath, our body tension, and our mind. We’re sort of pushing at the edge of it.

And as time goes on, we start to realize that we can actually push harder in that and harder in that. But as we do those things, we challenge it more, it’s not that we keep our breath perfectly calm or body tension perfectly calm or mind perfectly calm. We’re still the place where we feel like we’ve got some influence. We’ve got some capacity to feel like, “yes, I know I’m pushing hard and I’ve learned that I’m still safe here”.

I think that the key to that little piece is that there seems to always be if we’re paying attention well, and if we get skilled at paying attention, that there seems to always be a buffer between when the systems are trying to get you to stop and when you actually need to stop or otherwise risk damaging your body. Usually when are you going to exercise or moving is because we disconnect. We’re not paying attention. We’re actually deciding “no, I’ve got to get this done. I’m not going to listen to the signals that are coming up here.”.

Kathryn: Mm-hmm. Yeah. It’s really interesting to think about because I think that in a lot of classes, whether it’s yoga classes or other types of mindful movement classes, there’s a lot of cueing around we’re doing this but if it hurts, don’t do it. Or if it hurts, pull back or use a block or whatever. It really orients people to this, “well, if it hurts, it must be doing damage. It must be bad. So I don’t want to do that”.

Then we start to be like, “OK, well, let’s become more discerning and notice what your body tension is like and your breath is”. All these things. And then if the pain doesn’t go away in that moment, I think a lot of people are like, “oh well, the pain’s not going to go away, so I should stop because again, this must be bad”.

But what I’m hearing from you is: if you feel like you do still have influence over this movement or some type of capacity or some type of control, and you still can contract or relax or shift your breath a little bit, those are also signs that your body is probably not in immediate danger.

Neil Pearson: I think so. I wish I could be one hundred percent certain. I think if we have actually practiced awareness and practice regulation and pay attention…what’s happening with my breath, what’s happening with my mind, what’s happened to the pain…to be that discerning, you need to juggle a number of things at the same time or essentially divide your attention.

When we do that, you get more able to push yourself more, challenge yourself more, and remain in a safe place. And that’s part of this new program that we’ve created called Pain Care Aware. It’s bringing the language of pain science and actually the language yoga into yoga teaching.

It’s been really fascinating as we start to teach people how to do this because it makes sense how to do it in Yin classes. It makes sense to do it, to bring in the language of contentment and of permission and of compassion and of safety. All that stuff is so much easier for most people to do in a restorative or in Yin class, I guess. To bring it into Ashtanga or Svinanda or to bring it into Vinyasa class or like sort of core power stuff is harder, but it’s definitely possible.

It’s fun watching the teachers who are doing that to figure out how to integrate these languages. I guess in the midst of that, one of the things that they’re having to learn is that there’s some language that you actually need to take out. The language which provides an explicit message that pain equals damage. You know, if it hurts to do it, kind of stuff. We want to take it out.

And sometimes we hear things that are less definitive, things like, you know, “there’s a fine line between stress and damage”. Sometimes we say things like that. Sometimes we say, “make sure you do this to protect this part of your body”. See, a lot of that language is very much the language that creates a sense of fragility or creates more fear, like we’re trying to keep people safe. We’re actually increasing the sense of fragility and a sense of fear rather.

What we want to do is that people recognize the tissues in the body can actually get more able to tolerate load or force when we actually progressively start to load them more. Really it comes down to the guidelines of “can you keep a breath calm? Can you keep your mind calm? Your body tension low? To work that edge of the pain. Oftentimes, this is having to do with decreasing nervous system sensitivity or working with the nervous system. It’s also an approach that we can use to exercise in a way that will actually make the tissues of the body more able to withstand force.

Kathryn: I’m going to take the next minute to tell you about our incredible sponsor Offering Tree. On this podcast, we talk so much about accessibility and how we can make our work accessible for people out there in the world. But what can be challenging is teaching online isn’t always accessible for the teacher, for us behind the scenes. Because it’s tricky. It’s expensive. You got to figure all the technical stuff. This is why I love Offering Tree.

With Offering Tree, you can set up everything you need. A website, a blog and online store, membership, live classes. You can schedule appointments. You can do any combination of those things all in one place. And when you use our special link, you can do all of that for twenty dollars a month, when you sign up for the year.

If you don’t want to sign up for the year, there’s even more accessibility. You can sign up for three months and it’s only fifteen dollars a month. If you need help, there are real people behind the scenes that will do tech calls with you. They’ll show you how to use all of the different features. So if you get stuck, there’s always someone there who’s very patient and very knowledgeable. If you want to get your stuff online and help make your teaching more accessible and more sustainable for you as the teacher, go to offeringtree.com/mindfulstrengh

You have to use our link if you want to get that pricing. I love this company. I’m using them myself for the three hundred-hour training, It’s been incredible.

All right, everyone, now back to the show.

Kathryn: Yeah, OK, so right now I’m teaching this five-week class, this is the first time I’ve ever done this, so I’m thinking about it a lot. I’m teaching this 5-week class and it’s like Mindful Strength Movement for Pain Care. I found myself yesterday in my class…we’re going through this progression to get towards squatting. Everything from moving the ankles and the different joints to actually squatting with weights and squatting in a variety of different ways.

Yesterday I went through this little cueing about let’s squat with our feet turned in, a squat with our feet turned out. Let’s do all the different ways that you can imagine a squat could look like or could feel like, and then find the version of the squat where right now at this moment, you feel like you have the most capacity, where you feel strong in your body and in your movement.

Then I also notice myself saying, and that doesn’t necessarily mean that there’s not going to be pain there. Like you can have pain and you can still build strength. You can have pain, but you can still feel strong and have the capacity.

It was like the first time that I really noticed myself saying that explicitly about pain in a movement class.

Neil Pearson: I mean, first off, I think that’s fantastic because it’s almost like talking about pain during movement classes is taboo. It’s like we’re not allowed to. And the reality is that when we are pushing our body, even when we sit still, we still get pain like it’s part of the human condition.
It’s something that we experience when we are moving and challenging ourselves or staying still. And so, I mean, I think it’s really great that we get people to recognize that, yes, there can be some pain. This what we want to do: be curious about that.

Yes, there was some pain. Let’s actually notice what is going on here rather than if there’s pain, stop…say, “OK, this pain, its job is to tell us that we need to either stop or change your behavior, stop or change your behavior”. While you’re doing that squat, what would happen if you notice this pain?

What would happen if you ask yourself that question of, you know, do I think this is dangerous for my body to do? Or if you were to feel pain and you want to change the way you’re breathing or change tension in your body or change your expectations to play around and see what actually happened.

From what we can understand, it would be as if you could do it in a way that you could actually be curious and try changing things. And if you said, “well, you know, I did that and it still didn’t change the pain”, then probably the thing to do say, “well, you can keep on doing it right here because you just felt it while you did it when you were done it went away. Or what you can do is back off just a little bit. Either one would be a fine approach.

There’s one other piece about that I’d like to sort of go with nuts. Often we try to decide is just the right amount of activity by the amount of pain that we feel during the activity or the amount stress that we showed during the activity.

There’s another piece that we can use as a measurement tool, and that’s about recovery after we finish. I mean, even when we’re lifting heavy weights, it starts to hurt. And how do we know that that’s OK? We know it’s OK because when we stop and put it down, we recover relatively quickly. That happens and we go “oh ok”. Well, we may actually not actually think this sort of openly think it, but it’s almost like the systems of the body said, “oh, ok it hurts but I stopped in the pain went away. I recovered pretty fast. So that’s probably an OK thing to do is probably not a dangerous thing to do”.

Rather than using what happens when we provoking things as a measurement, whether it’s OK, we can actually look at both while I am moving, what’s happening in terms of something provoked. But also, when I stop, how long does it take to recover? The problem is I can’t say “yes you need to stop between twenty-one minutes. Then it’s all OK”. It’s not precise is that. But I think that’s another tool we can suggest to people is that: if you’re feeling pain during this movement if you stop and you recover quickly and then we’re pretty sure that’s an indication you did not cause damage to your body.

If you kept on doing that amount of activity that you could provoke it and then recover. Your body is going to adapt and become more strong, more healthy, more able to tolerate it.

Kathryn: What about the people who are doing their exercise, they’re feeling great. They go home, they’re feeling great, and then a couple of days later, they’re experiencing pain or like a flare-up.

Neil Pearson: That’s a hard one when it’s a couple of days later.

Kathryn: Yeah.

Neil Pearson: If a person had that, you call it a flare-up. If the person saying, you know, like, “I was fine for a couple of days and then it got worse”, physiologically, it’s really hard to attribute that to just the activity that you did two days ago.

If the activity actually did two days ago, was actually putting a load on the tissue enough to actually irritate the tissue to get these chemical mediators released, which had to do with pro-inflammatory chemistry was going to be released. It usually doesn’t take two days for that to build up like that.

There’s not enough to give you any increase in pain by two days later. That seems unlikely to explain. It may have more to do with this biopsychosocial is that pain is affected by everything.

Two days ago, I pushed my body really hard, and let us say it agitated things a little bit. It’s possible that in the two days between that maybe I’ve been worried and anxious that I actually pushed too hard. Maybe I haven’t been sleeping as well. Maybe I haven’t been living with for drinking enough water and all that stuff. Maybe I’ve been stressed at work. Pain typically in a situation like that is multifactorial, not singularly.

We tend to look for the simple linear connection between the pain’s worse, what’s the thing that I did that made the pain worse? I think if I’m exercising and I get more pain while doing it and I stop and the pain is worse, it’s more likely that’s a very specific linear connection. It was the mechanical load I put on my body that was more than my body can tolerate. Now I’ve got this inflammatory process or I’ve kicked up the nerves kind of thing.

But when it takes two days for it to happen, it’s more likely that there are multiple factors that are part of the reason why it took that long. I think it’s important for people hearing this to say that it doesn’t mean that what you did two days before had nothing to do with it. It just means that what you did two days before isn’t the only thing that explains this. It had to be some other factors that got involved to make it worse two days later.

Kathryn: Do you think sometimes in that case that it might not necessarily just be like the mechanical loads and mechanical stimulus on the tissue, but also like the overall threat of the exercise that that person did that day? Combined with the additional stressors or threats of life just accumulate sometimes and start to give us that feeling a couple of days later? Where like it might not actually have to do so much with the actual load on the tissue of the body, but just the overall, state that that form of exercise kind of provoked in the body.

Neil Pearson: The answer…I’m going with the answer is yes.
I think what we need to recognize is that pain is always like this. You know, the pain that we have, where we feel the pain, how much pain we have is always influenced by everything. But there are some times when it just looks way more linear and it looks more like “I did this with my body and now the pain is there. It happened while I was doing it and now I’m done. It’s there”.

But even in that situation, the amount of pain that you have, where you have it, how long it’s going to stay, it’s not just related to what you did to the tissues. It’s also how all the other systems of you are responding to what happened.

Even how the autonomic systems of the body are predicting what’s going to happen next week. It seems that something like that happened in the past where you push too hard and things were worse later it’s possible the system, the system was now predicting “you know, that happened, of course, is going to happen now”. And so that will have some influence on this as well.

Kathryn: A friend of mine told me a story today and said a couple of things about it. And I thought it was really interesting. I want to share this really brief, brief story with you and see what you think about this.

My friend yesterday did a workout. Took an online exercise class and worked out different parts of his body. And then a little while later that day was cycling and the bike slipped on the ice and he fell off of the bike. On the same day, he’s had a workout and a fall, and whatever else happened that day.

And then the next day we were talking and he was like, “I’m trying to figure out what I’m feeling right now because I can’t tell, like, the side of my body is sore, but I can’t tell if it was from that great workout that I did or if it was from the bike fall”.

“He’s like, I just can’t tell”. And I just had this moment of like, this is so interesting. Does your body know the difference? Do the tissues of your body know the difference between “I’m doing this exercise that I love and enjoy and I think it’s healthy and all these great feelings and falling off the bike”. I would imagine no one really enjoys.

Neil Pearson: Yeah. Can the body tell the difference? I guess I’m stuck with that. Do mean that the biopsychosocial spiritual entity in front of you or actually just talking about the physical body?

Kathryn: Well, so at first I was like, well, “do your tissues know the difference?” To the tissues, it’s just loads. It’s just here’s this kind of load and that kind of load. And the tissue is going to it’s either going to be too much or it’s going to adapt or it’s going to be whatever. But then the more I thought of it, I was like, well, the biopsychosocial a spiritual entity in front of, you know, I feel like there has to be a difference.
But I was going to ask you about this and see what you thought.

Neil Pearson: I think so. I think one of the things to consider is that if you can find a relatively similar person, so there would be two people who both did that class, two people who both fell and had the same loads on their body, their subsequent responses would be pretty darn different.

Kathryn: Yeah.

Neil Pearson: So our unique genetics, epigenetics history, worldviews, expectations, like all those things, are going to affect the pain that we have after a scenario that you mentioned.

Kathryn: I guess I was also thinking about it from the perspective of, we have an experience and then we feel the feelings, whether that’s immediately or the day after, and then we have feelings about those feelings. I feel like that is really influencing our pain experience. The feelings that I have after a great workout are probably really different feelings than if I fall off my bike. It just made me think of like the feelings about the feelings is so real. Even if to the tissue, it’s just a different kind of load.

Neil Pearson: Absolutely. And I think to me, it sounds like you are starting to talk about this from our perspective of human consciousness. And that’s when it really, really becomes harder to converse about this. You’ve had this situation and now you are experiencing certain things. Those experiences have been created by what’s happened. But now those experiences change every aspect of you. They change what you are thinking, they change your emotions, they change the chemistry of the body, the immune system. All those things are starting to change. And course, that changes the experience even more. Your response to those changes are going to once again change everything else.

Maybe I’ll say it a different way. The only way that we know what’s going on within us or we know what’s going on inside us is through the body. The body is actually the sampling device of the body and of the world. Does that make sense? If you change the sampling device, then that changes how it actually samples everything. If you have this crash on the ice and now you’ve had the crash and it’s had an effect on the physical tissues, the body. But it also has an effect, possibly, on your sense of mortality or your sense of confidence or competence in the world. Body changes a lot of stuff besides just the tissue. Right?

The autonomic nervous system is responding in different ways. The tissues responding in a different way, you’re thinking in a different way. All of that actually changes your physiology. When it changes your physiology, changes the way you now sample the world. You’re sampling the world from a different spot.

It’s a Sunday afternoon. You’re really calm. You’ve got some time, you want to just relax. You turn on the TV and watch some old Carey Grant movie. This Rom-Com kind of thing. And at the end of it, somebody taps on the window beside the chair you’re and you turn to look at your neighbor next door. They want to invite you over for a cup of tea or something.

As opposed to it’s the middle of the night and you’re up because your pain is keeping you up and you don’t know what to do, you needed something to distract you, so you turned on the TV. The only thing that was going to keep your mind off of the pain was a Stephen King movie. You watch now the Stephen King movie and at the very end of this, that same neighbor happens to tap on your window because he saw your light on. Now you just basically jump out of your skin. It’s the same sensory input, but the sampling device is reacting in a very different way.

Kathryn: Right.

Neil Pearson: That’s when we’ll start to talk about pain during movement. We almost need to sort of get to that complexity. How much pain we have during movements really does have to do with absolutely everything. Yes, the load on the tissue is important, but everything else is affecting it…including those signals coming from the tissues of the body that this person landed. The signals are passing up the spinal cord to the brain is going to be totally different, depending on how the person perceives it, depending on what your past history is, all those things.

Kathryn: Mm-hmm. Mm-hmm. That was a really great way of describing that. Thanks for sharing that. That’s a really good little example. Do you think that some people will just continue to have pain? Like, have you worked with people who maybe the pain changes a little bit, but it never quite goes away?

Neil Pearson: I really like this question. Interestingly it has been coming up a lot lately, in part because of the idea of should our goal, us in the therapy world, should our goal be pain relief? To answer your question is, will there be some people whose pain will go away? I have to say yes, because that’s what I’ve seen. And I’ve tried this idea around people working in the pain world and there’s some agreement on it.

If you look at the people I’ve seen that we’ve worked with, there’s this group of people who will say: “thank you so much. What you’ve done has helped me so much and the pain is pretty much gone. And I’m back to pretty much doing all the function I had before”. And that’s sort of a small group. But that happens.

Then there’s a much bigger group that says, “well, thank you very much, the pain is less than it was before. It’s not gone. It’s a lot less than once before. And I can do so much more again. There are still some things that I can’t do, but I can pretty much do a lot of my life again”.
Then there’s another small group who will say to us, “you know what, the pain really hasn’t changed, but you helped me get my life back”. To me, that’s the important point of this, is that somehow we’ve been led to believe that you can’t live well and have pain.

And I think I really think that we need to think about that a lot. My belief is that you can and I have that belief because I’ve seen people do it. I’ve had people telling me, “yes, it still hurts and I’m living a great life”. Maybe I’ll give it just a little sort of conjoined story with this. There’s a doctor that I know really well in Vancouver. In his last year of residency to be an anesthesiologist. If I remember the story correctly, he was on a chairlift at Whistler and it was the day that chairlift broke. And I think there were people who ended up paraplegics that day and so including him.

He said that after he had that injury, so this massive multi-million dollar machine turned on that helped take care of him. It helped him get back to life. He said there was no suggestion, yes or no, no explicit suggestion or no implicit suggestion that you could not live a full life and not be able to walk.

He said a few years later, he developed neuropathic leg pain because sometimes when there’s a spinal cord injury, because of the injury to the spinal cord neurons themselves, a person can end up with neuropathic pain from that. He said “everything was different. There is no big machine turned on to help him with his pain. And he said he did not get the same kind of message from people that life is possible when you actually have pain. And to me that, that’s really fascinating.

I think the majority of us if we saw somebody who would end up with spinal cord injury, you would understand that the messaging is you can live well and have this. Yes, there are limitations, and yes there are changes, but you can live well and be in a wheelchair. But we don’t have that same conviction when a person has ongoing pain.

And really, it’s the people in pain who taught me that, yes, you can have pain. Even sometimes the person says, “yeah, it’s pretty intense pain, but I’m living life well, again”.

Kathryn: Mm-hmm. Thank you so much for coming back on the podcast. I know you have a new course, Pain Care Aware. Do you want to tell us about that and who’s it for and how can people get signed up for it?

Neil Pearson: Sure. Thanks. It is primarily for yoga teachers. And so for those of you who know the other programs that we have, we have a program called Pain Care Yoga. It was really intended to focus on one-on-one yoga therapy. How to bring the understanding of science and lived experience of pain and pain care and integrate that with yoga as a therapeutic modality? We started to realize that there are lots of people who were teaching yoga classes and we want able to provide that same kind of knowledge to guide yoga teachers.

We came up with a sort of a bit of a tagline we say “it’s traditional yoga meets pain science…accepts that there is pain during yoga while promoting an approach to pain and language that promotes resilience and safety…without inadvertently creating fear of movement, helplessness when there’s pain or sense of fragility”. It’s a lot within it and it focuses a lot on how to bring awareness and regulation and discernment into what we do and to how to guide the classes with the language of yoga integrated with pain science.

So, as I said, it’s for yoga teachers. There are two levels to it. Level one is a fully online self-paced program, which with 30 hours of continuing education. Level two is more the practicum and certificate level, for those of people who actually want to practice. Level two is like a weekend that you get together with your peers. You review some of the information and then you practice with each other and give feedback to each other about how you are bringing in language of contentment and awareness and discernment and curiosity and compassion…keeping your language that would inadvertently create a sense of fragility.

The website is paincareaware.com and so you can go there and sign up for level one. We’re actually in the process of training trainers right now to do the level two. And so once they’re up and working, will be we’ll be setting up the weekend practicum courses as well.

Kathryn: Awesome. Well, thank you again for coming back on the podcast.

All right, everyone, I’ll see you again next week.

Kathryn Bruni-Young: And thank you again to our amazing sponsor Offering Tree. If folks want to get started getting your stuff online, go to offeringtree.com/mindfulstrengh. All right, everyone. I’ll see you next week.

Kathryn: That’s our show. Thank you, everyone, so much for listening. If you’re listening on the Apple Podcast and you’re loving the podcast, please consider leaving us to review. All of the reviews really, really help. If you want to learn more about my work, my membership, my teachers’ course, or my new free course called Mindful Strength Foundations, you can head over to mindfulstrength.ca