The Pain We Know – Professor Amy Wachholtz

In this latest episode of the GoHealth podcast we take a deep dive into the topic of pain, exploring what it is and how to live with it. Gillian tackles these big topics with Prof Amy Wachholtz is an Associate Professor in psychology at the university of Colorado where she is the director of health psychology. 

She specializes in talking a bio-psycho-social-spiritual approach in identifying ways to improve pain management including in palliative care, acute medical care, chronic pain and addiction. 

She is a psychologist who doesn’t just sit in the university but has a license to prescibe, working with patients in care, including those with cancer, chronic pain and at end of life. She is also holds a masters in divinity and has worked as a chaplain.  

Gillian and Amy cover:

• How Amy got into the field of pain research.
• What is pain?
• Why we sometimes don’t feel pain even when injured in some way.
• The relationship between physical, emotional and mental types of pain.
• The need for a holistic and integrated approach to main management.
• How faith influences living with pain.
• The Ken Pargament Model of the role of religion in pain tolerance.
• How church can help people living with pain.
• Being empowered to live with pain.

Links:

Find out more about Amy’s work a the Wachholtz Lab

Visit our website to get connected with the GoHealth Community.

Find us on our socials @GuildofHealth

Gillian Straine: Oh, that’s a lot, Amy, welcome to our podcast, it’s fantastic you’re able to join us. How are you today? 

Amy: Wonderful, thank you for having me. I’m looking forward to our discussion. 

Gillian: How did you get into this subject of pain as sort of, theoretical and practically? What’s your story? Why is it of such an interest to you in your life?

Amy: So this really became a, a passion for me. I was doing some work. I was working overseas as part of the UNHCR just subsequent to the Bosnian war, and I was a mental health relief worker and working with individuals from all age ranges who had the very traumatic experience of stepping on landmines or having family members that stepped on landmines and had traumatic amputations due to that. And obviously at that time, at that location, there wasn’t the level of pain management intervention, there wasn’t physical therapy, there wasn’t that availability that we would have in a UK system or a U.S. system. Yet somehow I was watching individuals get their lives back and at the time I didn’t have the scientific background or the scientific training to do any scientific kind of study but I was just asking people, what are you drawing on? What are the resources you have internally that keep you going, even in the midst of some pretty amazing pain levels as, as they’re healing from these traumatic amputations and they were sharing with me their social resources that they’re drawing on with their friends, their family. Their psychological resources, their hope for the future. Their spiritual resources, where they felt like they were being supported by their higher power. And all of this went into their level of pain that they were experiencing. And I found that fascinating. 

Gillian: Just going back to your original experiences, it sounds so powerful. Is there one person that you still have in your mind, somebody that’s stuck in your memory when you were telling that story there?

Amy: Probably the first person that I saw, it was a younger man, he was a teenager, he had just been out in the, the mountains of the area, kind of hiking, doing a little bit of light foraging for food and had stepped on a landmine and had, had lost the lower part of his leg. That was the first person that I had experienced with that kind of trauma. And he was the one that I was spending the most time with just asking questions of how are you, how do you keep going? What, what are you drawing on? Where is your hope for the future? And he was sharing, he was so generous in his sharing of his story with me. I don’t know what ended up happening to him after I left, but at some point I’d like to thank him because he really did change the trajectory of my life, my career, my research interests, my clinical interests and so that was a very powerful experience that I had. 

Gillian: And that would be some journey to go back on, to to find him. And the way you describe that enormously traumatic injury, but in the context of much social trauma, political trauma and trauma regarding the future, they couldn’t say what was going to happen, so a very complicated story. So, but can I take, I want to take it back really simply. So just before we popped on this podcast, I was baking Scottish Oatcakes, which I love, and I burnt my hand – I’m Okay, there’s no need to do an intervention, but you know, it really bloomin’ hurt. I did what my mum says, stick under the cold water tap, but what…can you tell us what is pain? What is it actually? Let’s start there and let’s build up to, you know, the bigger, the bigger things and the other frameworks we put around these experiences. What happened in my body like 20 minutes ago? 

Amy: Well, that’s, that’s actually a great question. So, you know, in our conceptualisation, how we think about pain has changed so much in the past 40 some odd years that, you know, for the longest time we all held onto Descartes and Cartesian dualism where the brain was over here and the body was over here and the two things never, never talked and that there was such a thing as real pain and then there was such a thing as the pain that’s in your mind. And I put both of those things in quotes because we now know that’s just non existent. There isn’t that dichotomy anymore and a lot of work was done in the late 1900s, early 2000 and started identifying that the old way that we think about pain where you stub your toe, it runs up the dorsal horn of your spinal column, it hits your brain and you say ouch!! We start started realising that’s not the way it actually works in the body.

So, for your example, you burnt your hand, it ran up the dorsal horn of the spinal column, you said ouch. But that’s not the end of the story or even the beginning of the story, because your pain experience is very different based on what we’ve now identified as top down things that will balance those signals that are coming from the body.

So, for example, if you were, you know, your make your oatcakes, you were singing along to your favourite song, you’re laughing, you’re talking with people in the kitchen. We know from research that because you’re cognitively distracted, you’re in a really good mood. Maybe other things are going on around you that are very positive. Your ultimate experience of those signals that are coming from your body are going to be balanced by the thoughts, the emotions, the behaviours that are balancing that from the top down.

And so what ends up happening is, well the signals will still come from the body and they’ll come from the body at the rate they’re going to, your actual pain experience is fully determined by those thoughts, emotions and behaviours that are currently going on in your system. And that what ends up happening is there’s an area of the brain called the anterior cingulate cortex that acts almost like a volume button that you’ll either dials up the signals that are coming from your body or dials down the signals that are coming from your body.

And so in times when, like I said, if you’re distracted, you’re happy, things like that, your actual pain experience might be lower even with the same burn. But in most people have had this experience a little bit, a little bit where they’ve been busy, they’ve been active, they’ve been doing something, maybe they’ve been playing sports or just doing something in their, their home and they wake up the next morning, they have a bruise and you’re like, how’d that get there, I don’t remember explicitly injuring myself, but they broke blood tests, they did tissue damage, and yet at the same time, they cognitively didn’t register, their brain didn’t register it as a pain signal.

Gillian: Yeah, and in more extreme, I’ve heard of people playing sports events and carrying on their life, discover they’ve broken a bone or something really much more extreme than a than a bruise or a small burn. Can, can some people not feel pain at all, or will the pain always come? 

Amy: That’s almost two different questions. So there are some people that are genetically born with a disorder where they don’t feel any pain. That is actually a a problem for individuals because they will break bones, they’ll stub toes, they will have an infection and they won’t realise it. And so it can actually become very problematic because pain is also a useful signal for us in many ways, that it’s telling us the signals from our body is telling us, hey, there’s something wrong, you need to pay attention to this. And so not feeling any pain can be problematic. But for individuals that would have a quote, unquote normal experience of pain, but temporarily the adrenaline is overwhelming or they’re laughing with friends while it happens and they stubbed their toe and they don’t even really know, they’re out with friends on a Friday night, they stub their toe and they don’t even realise it till they get home. Oh wait, that really hurts because they’ve been so busy and active and cognitively distracted. So in those cases, the pain may come when things are quieter or when the brain is less distracted. And then and then the brain can finally wave that red flag at a level that somebody might hear it of, like, hey, there’s a problem. There’s a problem here. You need to pay attention to this. So in those cases, the pain may come, but it may come a bit later. 

Gillian: So we’re talking a lot about physical pain, burns, stubbing your toe and things like that. What about other types of pain? You know, the pain of, of loss, the pain of grief. Same thing, Different thing? You can’t see the pain, you can see a broken leg or a bruise. You can’t see the pain of grief. You know, how are you as a specialist approaching this different apparent, different types of pain? The research on that area has really broken down a lot of that Cartesian dualism I was talking about earlier, that we know that if we put somebody in an FMRI scanner and we ask them to think about a loved one that they lost or if they’re going through a very painful breakup or a divorce, and that we ask them to experience that grief, it lights up a significant same number of areas of the brain as if we

were to give you a shock on the hand. So physical pain and psychological pain, spiritual pain, these things are all actually intertwined at a level that we never really appreciated or anticipated before. It is the same way that sometimes people will say, you know, whenever they’re experiencing significant grief or they’re experiencing significant depression, they’ll experience this diffuse full body pain, even though there’s not an identifiable reason for them, quote, unquote, reason for them to have that pain. And what we’ve learned is that, that’s exactly what we’re pointing to, where all of the brain, the body, these things are so intertwined that if, if one part of that individual is suffering, all of the areas of the body and the brain and the spirit maybe suffer, may be suffering along with it. When you’re feeling pain to make sure that you’re understanding the source of the pain so that it can get treated properly. Because if you use, for example, biomedical approaches to treat spiritual pain, you know, opioids make everything better temporarily, but it may not treat a dark night of the soul. It may not treat a spiritual pain, it may not treat this psychological pain. And so you’re not actually getting at the source of the pain. 

Gillian: Can I just go back to that scanner? So let’s like hypothetically, you’ve got three scanners. One person with a broken leg, one person’s just lost a love of their life, the other person is in an existential crisis around meaning, facing dark night of the soul. You’re saying that if you scanned the brains they’re, they’re lighting up similar areas of the brain. Can you put a number on that? This is you know, there’s no referencing required, is it over, like, is it 50% of the brain is the same lighting up for all these different types of pain. If so, that’s extraordinary.

Amy: It can be above 80%. I’ve seen one study that it was actually above 90%. So it depends a little bit on the method. There’s different methodologies that can be used for FMRI scanning, but above 80% that you’re seeing such a tight overlap and like in the upper eighties, maybe even lower nineties, that we’re really seeing that overlap. And so this isn’t like a a passing connection. This is something that this really is deeply embedded in who we are. 

Gillian: So different types of pain. We live in bodies, brains all, you know, embodied together. There’s overlap between them all, but, but there’s different ways of perceiving the pain, depending on what you, what you’re going through and either in the moment, it’s not the time to process it, the house is on fire – you need to get out or maybe emotionally and spiritually – it’s good information, there’ll be a time to process it. 

There’s a Buddhist phrase that pain is inevitable, but suffering is avoidable. From a Christian perspective, there’s good resonance of what we think. You know, we are at a distance from God, there’s sin and suffering in the world. Can’t really avoid it. But what you’re saying, science might be helping us understand ways in which to experience that pain and suffering. And that some things might help more than others. 

Amy: I think that’s very much the case. If someone feels that there is meaning and purpose in their suffering or in their experience, the suffering component of that, it’s going to be much, much lower. Even if we think of people who voluntarily give up, either for short periods of time and they go on mission trips or they or for a longer period of time and they dedicate their lives to the church or to a, a group where they’re giving up something. Their experience, they could be experiencing deprivation, whether that’s sleep deprivation, whether that’s physical deprivation, whether it’s health care deprivation, because they feel they really are dedicated to Doctors Without Borders, for example. For a spiritual reason they’re going to go work in Doctors Without Borders, and they’ve gone from a fairly nice, cushy life, hot running water at the turn of the tap to someplace where there’s deprivation. There may be hunger. They may not have some of their basic needs filled 24/7, like they’ve been used to. And yet because they feel that, that’s critically important to who they are, because they feel like this is part of their mission in life, that’s something they’re willing to do, so, they may be experiencing pain, they may be experiencing deprivation, but they don’t experience the suffering. 

Gillian: But what about people who, what about people who are living with chronic pain, that there is, you know, so they’re not, there’s no chance maybe of a cure, in inverted commas, the medical…you know what what can help with their suffering or what can we learn from those who live with chronic pain about what can help?

Amy: And this is something that is very close to my heart. This is something that I really feel passionate about because I feel like patients who are living with chronic pain have largely been undertreated or the issues have been under addressed or they’ve been addressed in the wrong direction, that they’re, it really does take a bio psycho social spiritual approach to address chronic pain, because oftentimes, at least in the U.S., by the time someone comes to see a pain psychologist or they’re able to get in to see a pain psychologist, if they get in to see one at all, this is just the patients that do make it into it.

They’ve usually been experiencing pain for ten years, at which point the signals from the body have happened over and over and over again for ten years to the point where the brain almost doesn’t need the signals from the body anymore. It becomes what’s called centralized and the brain just starts dancing away to its own tune because it says, I know this rhythm, I know this tune, I can keep dancing. Even an absence of signals from the body, the brain is just like, ‘Yeah, I already know this. You’ve been doing this for ten years’. And so trying to only address pain at the level of the body, which is where a lot of Western biomedicine lives, are really neglecting the centralised pain that then has been occurring that these circuits have developed over that period of time of ten years. And so really working with pain psychology to address, okay, what’s going into this, how has this changed how I see myself? how is this change, my self-identity? my self esteem? how has this changed where I find value in life? How has this changed the fun I get to have? The social, my social networks? Again, that’s where pain psychology comes in. Not that we diminish the value of Western biomedicine on the rest of the body, but that only by focusing on the pain, on the signals that are coming from the body to the brain, you’re missing the centralised component of the brain that is now fully in control of analysing, assessing and deciding the volume of those signals that are coming from the body. And in, in absence or in neglect of addressing those issues, it can leave pain patients only partially treated or not fully treated.

Gillian: Only looking at the bio bit? You keep saying, keeps it in bio social psych. So they’re only looking at one, the bio bit.

 

Amy: They are only looking at the bio bit and they’re not looking at the psycho social spiritual components that also go into that pain experience.

Gillian: I mean, often in our work in GoHealth, we are, our thing is healing, right? But we talk about healing as finding out who you are. And if we find deep connection with our bodies, whatever state they’re in, our emotional life and our psychological life and our spiritual life, we’ll find out and look for integration within those, in whatever circumstances we find ourselves. We talk about that as healing. We talk that when we can do that, then we will flourish. And the Christian angle is, when we do that, we’ll find our deep connection with God. So it sounds like when you’re suggesting that people with chronic pain would be helped by a bio-psycho-social model, I’ve written it down. You’re actually talking about deep healing because you’re talking about helping that person find out who they are now in the reality of the limits that they have to live in. Or maybe, I don’t mean limits. I mean, you know, reality with the, you know, the path they’ve been on so far. There’s some kind of coming to terms thing, it sounds like, that’s going to help with pain management. 

Amy: Absolutely. And the approach that that biopsychosocialspiritual approach really helps empower patients that are struggling with chronic pain because for so, so many patients that I talk to, they have, just by nature of how our systems, our medical systems work, they’ve given power over control of their pain to their physician or to this magic pill. And I’m not anti medicine in any way, shape or form, we need western biomedicine to address certain parts of whatever works we’re struggling with. But that’s not the only piece. That’s that’s the component of it, that it’s not the only piece. And so making sure that someone has yeah, identified who they are in this new reality, while also accepting that the reality may change as someone begins to heal, they may find themselves – healing broadly defined – healing may not necessarily be getting better from the physical standpoint, but because of those top down components of determining what the volume of that those signals are coming from the body, healing can happen from a biological standpoint, from a psychological standpoint, from a spiritual standpoint, from a social standpoint, and really taking into account all of those pieces. So starting with, who am I now? Who do I want to be? and how am I going to get there? So if a patient comes into my office and on that zero to ten pain scale, what’s your pain? That’s a very common question, that at least in the US medical systems, people always ask us, on a zero to ten pain scale what is your pain today?  I am less interested in what that pain number is and I’m more interested in what somebody says. Okay, your pain is at a six. That’s not great. It’s not bad. Non-judgmental. 

But what I’m more interested in is what can you do with your pain being a six? What does that mean for your life? And where do you find meaning in your life right now? And where would you like to find meaning in your life so that the pain becomes a piece of somebody’s identity but it doesn’t, it stops becoming their entire identity. 

Gillian: Yeah. Who they are. And I love what you’re saying about helping people feel empowered in medical systems as well. And we hear that not just for talking about pain, but, you know, so many people’s story as well it be and they lose power when they come into the medical system and part of the healing and certainly from my perspective as a cancer survivor, that’s that was a huge part of my healing. I got medical healing, thank God, went into remission, but a lot of it was on finding out who I was now after. But Amy, I was just wondering, I actually, I imagine I imagine you going to somebody’s bed, right? And you’ve..and the opioids aren’t working and they get to you. And I don’t know, but I bet I would bet the people living with chronic pain or complex stuff, they sometimes have either been told to their face or maybe even suspect themselves that it’s all in their head. You know, ‘we’ve done the X-rays, we can’t find anything, go speak to Amy. And do you ever have any resistance? Now they’re just going to talk…I’m just being sent…you know. Must be something wrong with, wrong with me in another way. Do you ever get a resistance for people wanting, people when they meet you, to be able to understand the biopsychosocial model that you, that you want to work with them to help with their pain?

Amy: Absolutely. And I’ve actually done a lot of, I’m surrounded by a great medical team, but I usually find whenever I move to a new location, I’ve worked in three medical systems now throughout my career. I usually have to do some pretty intense training of the medical staff of even how do you talk about a referral to a pain psychologist so that they can, and helping patients, when they make the referral so it doesn’t come off as like, well, I think you’re just addicted to pain meds or I think you’re it’s all in your head or I think you’re lying or I think you’re looking for secondary gain. How do you talk about that in the referral so that there is less resistance on the outside? And, and usually the medical providers I work with have been wonderful and very willing to change their script around these referrals as they bring me in so that there’s increased or there’s decreasing resistance the longer I’m in a, in a centre over time because that and some of that I joke that I like, I start by telling the medical students who then rotate to other, other areas of the hospital and then they teach the residents or junior doctors and your language, your terminology, who then teach the attendings who act like they knew it all along. But it starts from the students excellent teaching upwards. 

Gillian: Bit of human psychology never, never hurts, does it? 

Amy: And so then that really helps. And then I really start with, a little bit of that description of the top down to the bottom up processing. And I start with some of the descriptions of what’s called the gait controller, the neuro matrix theories of pain. And then I stop with…I really start with saying, I almost describe it as, of course, pain is in all in your head. Where do you think it’s going to be processed? Usually patients are like, oh, yeah, okay, now that makes sense. Now I get what you’re on. And then I say, pain psychology, we’re not here about taking away your meds without help, helping your meds work better.

And we help the brain do the thing that accidentally once in a while it does and teaches you how to harness it so that you again, are more in control of your pain and that you can feel like you get to control your life a little bit more rather than feel like pain determines how much control you have over your life.

And so this really is about giving pain back so that they can control it. And again, the more tools somebody has, the more strategies that they’re able to do, the more that they’re able to harness the power of the brain again, to do the thing that the brain already does once in a while, but they can do it more intently. It also becomes, pain also becomes a lot less fearful, which then in that top down processing, you feel the signals, you’re like, well, that’s not great, but it’s not scary because you have a a plethora of tools that you’re like, okay, I can use this. I know I can make this better or I know I can get through this and it, because it’s less scary that also actually brings down the actual experience of pain. 

Gillian: Lowering fear, getting getting back control. Sorry, that’s a terrible phrase to use in the UK. But, you know. Helping people feel empowered in a system that’s taken away their power. Sounds like there’s, I mean, this is this is good science. This is good psychology. There’s also bigger stuff for, I think, learn, everyday learning as well. You mentioned tools, right? So really simplistic, medical doctors have a bunch of tools. They can prescribe those opioids`, they might have to operate if that might help, other kind of drugs and interventions. You and your colleagues in pain psychology have a whole bunch of other tools that the rest of us don’t. But let’s talk about the spiritual tools that we can all have as Christians or spiritual people to help with pain, perception, pain relief, or living with pain.

What is it in our Christian spiritual, theological community traditions? Whichever angle you want, that can help with pain relief? 

Amy: Absolutely. And that’s that is a great question. So I feel like I do need to back up a little bit and talk a little bit about the model that I work with in, in psycho spiritual approaches. And so I do use the Ken Pargament model that he developed, and it’s a, it’s a four step, but it’s a four part model that really talks about how people interact with their higher power. And the lovely thing about this model is that it has been verified in Christian traditions and Jewish traditions, in Buddhist traditions and Hindu traditions and Muslim traditions and in other worlds traditions. So it’s, it really is as far as we found so far, it really is a universal model. 

Gillian: So four steps. Take me through them quickly. Yeah. 

Amy: So the first, the first method is, it’s all about how somebody interacts with their higher power. So the first approach is the collaborative model. And this is somebody who says, you know what, I’m going to do my part to address the medical issue, but I’m also relying on God or my higher power to support me through that. So if somebody is coming through and they had, for example, a car accident and they’re having chronic low back pain from that, they’re going to say, you know what, I’m going to do my physical therapy exercises – that’s on me. But on the days when I feel like I just don’t feel like getting up out of bed and doing my physical therapy exercises, I know my higher power is going to be there to support me. And that’s the collaborative model. Individuals using this model really do the best across biological, psychological, social and spiritual domains.

Gillian:  The best being pain reduction?

Amy: with pain reduction and actually in any collaborative biomedical issue.

Gillian: Okay, what are the other three? 

Amy: So the other three. So one is deferring and this is one where somebody says, you know, it’s all in my higher power since I have no control over it, there’s nothing I can do about this. So I’m just, God’s going to heal my back. And, you know, if I don’t do my physical exercises, it doesn’t matter. And so individuals within this group tend to not do very well. The one exception to this is palliative care, when they’re, when somebody is not just palliative care, but hospice care, where they’re really looking at end of life. But otherwise generally being, being personally passive and expecting a higher power to do everything, that does not tend to have the best outcomes. So the collaborative model tends to best. The third model is what’s called independent, and this is where individuals, maybe they’re not raised in a tradition, God is not involved. They don’t have a belief, they don’t have a background in it. There’s not a negative emotional component to it. It’s not like they left the church because they’re angry about it. They just, they are neutral about the, about the higher power. And individuals, they’re like, I have to do my physical therapy exercise because there’s nobody else to do it for me. And individuals, they don’t do badly, but they don’t do as well as the collaborative individuals using the collaborative model. And then the final group is a group that I always really train my medical colleagues to listen for. And these are individuals that it’s called the abandoned or punished interaction. And this is one where they’re saying, God isn’t involved because I’m either being punished for something or God has abandoned me in my time of need. And this is a major red flag. This is something where individuals can get the same level of biomedical treatment, and yet their pain levels are going to be so much higher across the board. They’re going to often be also struggling with, again, where we we talk about that biopsychosocial spiritual model, they might also be struggling with guilt at being punished, ‘I got in that car accident because I cheated on my partner’. And so they’re also struggling with the guilt component of that as well as whatever pain signals are coming from the body. They may be having depression, they may be having anxiety, they may be struggling with their spirituality in light of whatever it is that they’re feeling like God is punishing them to do or has abandoned them for that reason. And so again, it becomes multidimensional pain. It’s not even though, yes, there are signals that are coming from the back that’s causing chronic back pain, There’s also signals that are coming from the brain that are amplifying or dialing up the volume of those pain signals. And so individuals that are in this abandoned or punished, across the board and over time feel more pain. They experience greater depression, greater anxiety. And if that is not addressed, then that trajectory, there’s nothing to change that trajectory either. So that’s where it really becomes multi focal pain experience that needs to be addressed, not just on the biomedical side, but also in the psycho spiritual and social side as well.

Gillian: So collaborative is what we should be aiming for and actually at GoHealth we take the collaborative approach. We say, look after your bodies, they are gifts. Exercise, we talk about mental health, physical health, spiritual health –  all intertwined. So I feel like we’ve got a big tick there. This is good. But what else? What other spiritual practices help with pain? Pain…I want to say relief, but pain perception and living with it. Can you reel them off? I mean, we all hear about meditation, mindfulness, going outside. And what about what we do in our churches, Amy? If you could talk about that as well, because there’s so much, it’s not just worship of God, it’s not just receiving the sacrament if that’s tradition – you’ve got the welcome at the door, you’ve got maybe the beauty of the ancient place, a light, a candle, speak to somebody over a cup of tea, sing hymns together, sing stuff together. What are so, first of all, what are the spiritual practices and what particularly could we be doing in our church communities, or doing better? We understand them as potential pain perception reduction devices, oh won’t call them that. But, you know, you know what I’m saying? 

Amy: Well, I love to…you, you actually listed a couple of of wonderful, wonderful things. So if somebody is musically oriented, they will they may say, you know what, that hymn today, I just I felt it in a very deep place and for a moment, my pain went away. So if somebody is musically oriented, then the music in our churches, group singing has shown to be, can be very powerful for some people. That can be, that can be a wonderful tool for individuals. Feeling that sense of community, the greeting at the door, having that that social moment over a cup of tea, you know, prayer and meditation obviously can be very useful. We have learned that prayer for oneself tends to be a little bit less adaptive. `So just praying that you’re paying your pain goes away, doesn’t tend to have a lot of pain relief. But when we shift that focus outward to other people in our community, that actually tends to show a lot of pain relief. So not just in prayer, but in volunteering or helping other people actually shows a reduction in pain. 

Gillian: So what’s that about?

Amy: That’s a really good question. I think that’s something that we need to study a little bit more. But it’s when you take that focus away from yourself and say, yeah, I’m in, I’m in pain, I’m not doing well and you don’t want to overdo it. That’s the other piece you want to do. You don’t want to get to the point where you’re overdoing something and then you’re going to be in pain for the next three days. But for, in small and in building ways, you say, ‘you know what? Yeah, I’m, I’m having some pain, but I can sit in a chair and I can tutor a kid and I can focus on that kid for a little bit of time, or I can help a little bit on Meals with Wheels and help somebody else or our community, community, community meals or I can help somebody else. Yes. I’m not feeling good and I acknowledge that. But I can still I still have it in my body to help somebody else. And I still have it in my mind and in my spiritual nature to help somebody else.’ And when we turn that outward, something happens and we haven’t really identified what that something is. But when somebody finds meaning and purpose in external activities, it actually dials down their own pain experience.

Gillian: Wow. We do that so much, you know, in our just – it happens in loads of other places, but we are talk about church a lot, finding those opportunities to look outwards, you know, it happens so much through community activities that happen in church and that gives us connection to others – maybe we are supposed to be connected. So somehow that’s finding out who we are. We have that connection bit, that gives us frameworks. But also in church we have that ultimate framework of meaning, don’t we as well around what we believe, particularly through Jesus life, death and resurrection. But I want to ask a question about the connecting bit, because you know what, in churches all the time, not all the time, some churches are great. You do the, ‘how are you? I’m fine. How are you?’ And everyone’s just lying, not big lying, but they’re not being truthful. I had an experience the other day. I was in hospital unexpectedly for two nights, found myself on a ward with four, six other women, and it was an extraordinary…and I’m fine, thank God for our medical system, etc., etc. it was an extraordinary experience because we all chatted as women. It was very amazing nursing staff. But anyway, no one said,’fine, how are you?’ ‘I’m fine, how are you?’ Because it was blatantly obvious and none of us were fine. So we kind of like skipped over that bit. And you know, I share what I was worried  about, the woman opposite me, she’d had a cardiac arrest in the school staff room one day and one diagonally opposite, she had a stroke, possibly could have had the stroke might been… you know…and everybody…the 97 year old next to me didn’t know if she was ever going to get home.

And, you know, we all shared, we skipped the whole kind of mask, false thing and we shared our experience and then we had a laugh about the, you know, and actually it was an experience, it wasn’t an experience of church, there was no hymns. There was there was well, actually lots of rubbish tea. But, you know, there’s definitely no churchy stuff. But there was something happened in that space that was deeply healing. I wasn’t in pain, pain, but it helped me heal from the experience quicker because I felt like I wasn’t alone and I wonder if that’s something in terms, in going back to pain, that we can do in churches is we can just drop the social niceties every now and then, or just a little bit, that might help?

Amy: And what a wonderful healing conversation that, that moment that you had, that it was. What a special healing. And I would even call it a spiritual conversation, because you made a connection to complete strangers or people who were a complete strangers when you came into that room. You weren’t complete strangers when you left. And there’s something really wonderful that happens in that moment. And absolutely, I think sometimes we want to be careful not to put our burdens on other people. And so we say, fine, I’m fine. And and, and for the most part, maybe other people are dealing with their own burdens and, and aren’t ready to pick up your burdens. 

Gillian: Yes. 

Amy: But finding that, that group of people that are ready to share the burdens and realising that sometimes shared burdens are lighter burdens, that when you, when you’re able to have that conversation, that really is healing, that the burden becomes lighter. And it’s not so much that you are giving your burden to somebody else, but that by sharing your burden and through that conversation, it can become lighter. And if there’s worries that somebody has, if there’s concerns somebody can provide emotional support, they can sometimes they’ll provide instrumental support. You know, I don’t know how I’m going to get to this doctor’s visit. My car broke down, the bus schedule…you know, the bus is on strike or something where somebody is like, ‘well, I can take you.’ That becomes an instrumental support. It’s a tangible support, but it provides so much relief and it can become that lightning of your burden as well. But that can also happen emotionally as well, you know. So it does, it’s not just but there’s also emotional and spiritual moments as well that shared burdens can become lighter burdens. When you find that point of connection.

Gillian: I’m thinking of us, we’re all in our beds…Now I know what I know, having talked to you, there was a woman in pain, she’d done her back and she couldn’t move, she was yelling. But there was lot of emotional pain and some existential pain. And I’m just imagining, if we’d all been in the scanners, this, up to 80% of the same bits of our brain would be firing. And the healing we found in finding connection is extraordinary. And that’s that. Robin Williams you know, quotation, the actor, you know, ‘be kind, you never know what somebody’s carrying around.’ We all have bits of those brains firing at least some of the time, I guess. 

Amy: We have to think that magic or not magic – don’t want to use that that – that special conversation that you had, not only were you willing to share your burden, but you were willing to hear other people’s burden’s as well. And so it also wasn’t a one way street. It was that two way street where you were or six way street in this case where you were all willing to share. Yeah. And you were also all willing to listen. Yes. Yeah. Because I think that’s a critical component to us, finding that space to listen. 

Gillian: Yeah. Yeah, absolutely. Although I had started reading up on the podcast –  nurses would come round every hour to all six people and say, are you in pain? And in my head I go, no, you mean, are you suffering? So I know, don’t say it out loud, Gillian, they’ll think you’re an idiot. So anyway, it was an extraordinary experience and I feel changed by them, even though I spent 48 hours. I feel like a little bit of who I am changed slightly from that experience. 

Amy: You might have also been seen as light years ahead of your time.

Gillian: Okay. [Laughter] Anyway, I got out.  We have to bring the conversation to a close, unfortunately, Amy, But I just want to finish on this question. In fact, this is a question I asked you when we first met, months ago, and the question I asked you was, what do you wish people knew about pain? You’ve got all these studies, you can prescribe, you thought about this a lot, from that moment you started in Bosnia to what you’re doing today, somebody might be listening right now in pain. What do you wish they knew? The one thing you wish they knew. 

Amy: I wish they knew they have more control over their pain than they realise, that they’ve been taught to realise and that they can be empowered to…sometimes we even see it like you end up re-routing circuits with pain psychology that this can happen and that you don’t have to feel out of control and at the mercy of a system that controls you and that this is your body. This body can be, is part of you, it’s integrated with your brain, it’s integrated with your mind, and that all of these pieces can come together to help you not feel like pain is controlling your life. It’s not quick, it’s not easy. I don’t want to make it sound like it’s anybody’s fault, that they are still, that they are experiencing pain or that they have a pain flare, I certainly do not, would never want anybody to experience that. But I’m saying that there’s hope, there’s, there’s ways that you can become more empowered. There’s ways that you can get to a point where you feel more in control of your pain, where pain becomes a signal from your body rather than the identity of who you are.

Gillian: Amy, thank you so much for giving us your time, for adding such good science and knowledge stuff, but also such wisdom and compassion to our exploration of pain and what we can do together within our spiritual tradition, within the church tradition, within our churches to help with the pain we all know maybe right now, but at some point in our lives.

So we are, it is not the end. We are going to be picking up the conversation over in the GoHealth Community. So if you’re listening at home right now, we’d love to know your thoughts. Do you have a story about spiritual practices, about pain relief in your own life? We will be chatting about this over in the GoHealth Community.

Thank you to Rosie Dawson, our producer. Thank you also to Wendy Lloyd from the Go Health Team For all her work on this series and this podcast, if you’re listening, please hit share and like, it makes an enormous difference. We’re not in it for the numbers, but we are in it to get this conversation out to as many people as possible so they can learn about our work in the GoHealth Community, where together we seek to flourish and be healing presences to one another in the world today. Thank you so much, Amy, for giving us your time today. 

Amy: Thank you for having me.