Radical? Radical!


Welcome to 2021! An interesting start to the year for my US friends, more of the same for my UK and European friends, and life in NZ and Australia goes on with an added dash of uncertainty because of the new! improved! more contagious Covid19!

I’ve had a few weeks away from my usual Monday morning writing routine, but I return to the blog today with a lovely book I’ve reviewed. There’s no secret about my personal preference for ACT both for living and flourishing in daily life, and for those of us living with persistent pain. Today’s book review is about Radical Relief: A guide to overcome chronic pain, written by Joe Tatta, physiotherapist. From the outset, I’ll acknowledge that I was sent a free promotional copy of this book – but I would have bought it anyway, I promise!

There are a few books I recommend for clinicians working with people living with pain. The first is a textbook called Pain: A textbook for health professionals which is one of the most accessible and clinically useful books for clinicians wanting to enhance their understanding beyond what they learned in undergrad training.

Another is an old CBT-based book written by Turk and Winter called The Pain Survival Guide which runs through the main conventional approaches to managing pain. It’s written for people with pain, and while there are certain parts I’m not certain are really well-supported by research, it offers the standard strategies that have been included in multi- and inter-professional pain management for years.

And now, Radical Relief arrives on the scene, and I think it will be another of those references I will use over and again. Radical Relief is written for people living with pain. It offers a “radical” way to returning to life, drawing on well-established, well-researched strategies for pain management from an Acceptance and Commitment Therapy perspective. For those who are not familiar with ACT, one of the major premises is that often our problem-solving mind gets in the way of us living a values-aligned life, particularly when we’re confronted with a situation or experience we can’t change.

Now I’m going to take a moment to comment on pain changing. Pain changes all the time. The intensity can go up and down. The quality might be intrusive – or fade into the background. It might be there all the time, or intermittently, or unexpectedly. There are so many factors that influence our experience of pain that it wouldn’t be at all surprising to find that most clinicians find that their patients experience at least some relief during or after treatment. And sometimes we clinicians like to take credit for that – and often we want to focus on getting a report from the patient that yes, pain has reduced. Sometimes we’ll almost do anything we can to find a way to “reduce the pain.” Part of the definition of pain (see here for the full definition and notes) includes the word “unpleasant” – “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”, so I think it’s safe to assume most of us don’t want to experience pain. And yet we know that for many people, reducing pain intensity is not possible. That’s a fact that some clinicians don’t want to recognise. How we as clinicians handle our inability to alter pain intensity is a test of our willingness to read and acknowledge scientific literature.

OK, back to the book. ACT is based on the idea that underpinning successfully navigating life is a concept called psychological flexibility. This concept consists of six processes that appear to underpin how we can be psychologically flexible in the face of an unpredictable and challenging world. Joe Tatta, in this book, articulates these processes as they can be employed by people living with pain. How to be open, willing, aware and do what matters to you in the presence of pain, and all that this experience brings with it.

I won’t review how ACT might help – there’s plenty of information available on the web, including my blog, for those who aren’t familiar with it. I will, though, say that the way Joe writes is clear, succinct and empty of jargon. He writes as if he’s speaking directly to the reader. The sentences are short and full of questions to ask yourself. The chapters are also short and offer activities to try. Joe identifies that some of the activities might feel odd – they’re not “typical” of many self-help suggestions, because Joe invites readers to experiment, to try, to see what happens, to be open to what happens. This is refreshing!

Some features of this book that I particularly like are the room to write your own thoughts and responses down. The certificate at the end of the book is delightful. And the illustrations – gorgeous!

I think if I was a person who came across this book I’d be intrigued by it. I think I’d find it easy to read, and I’d be willing to try at least some of the ways Joe suggests. If I worked through this with a clinician, I think I’d find it even more useful. It’s not easy to step outside of yourself and recognise your mind’s sticky thoughts and attitudes. It’s hard to make changes on your own. So it’s not the way the book is written that means I’d suggest using it with the support of a coach or clinician, it’s simply the nature of motivation to change in the face of pain.

Now ACT has been found to be no more (and no less) effective than CBT (or indeed any other treatment approach we have: surgery, medications, exercise) for persistent pain. This doesn’t mean ACT “doesn’t work” – it just means that, like any of our approaches to persistent pain management, it’s not a case of one size fits all, or one therapy will be the magic bullet. I’ve advocated for a while that precisely because we have no over-arching “successful” treatment, this offers clinicians and people with pain an opportunity to find out the unique combination of strategies that are helpful for this person at this time and in this context. ACT, although it includes the term “acceptance” does not mean “resignation” – I prefer the term “willingness” to experience pain (rather than doing everything possible to suppress or avoid pain) in the pursuit of what matters. ACT’s functional contextualist philosophy means we need to ask “how well is this working?” about everything we do – because the ultimate measure of success is about whether the approach is helping us do what matters in a particular context. I think that’s pretty radical myself. And, like this book, while we won’t always have a “perfect” outcome, we can MOVE.

M= Make room for unpleasant sensations (and thoughts!)

O= Open up and observe non-judgementally

V= Values guide life, not pain

E= Engage in activities in line with your values

Thanks for the opportunity to review your book Joe, I appreciated it very much.

9 comments

  1. Hi Bronnie,

    It was insightful to read your review and unique lens of Radical Relief. The first book I read about pain as a clinician was Explain Pain by David Butler. It was recommended to me by a Naturopath and manual therapy practitioner at the time. It helped deepen my own understanding and speak to patients about their pain in a different way. It gave me some tools in my toolkit to create resources for them. I have since read many studies and articles. This is such an important topic in healthcare and yet it is so misunderstood. Patients with chronic pain need to be met where they are at and our plan of care should match the patient’s individual needs. What I find fascinating is that the solutions often lie at the intersection of the patient’s physical sensations and psychological processes. Clinicians need more resources to navigate this complexity.
    Thank you for the recommendations. I will look for this book and the others you have listed and add them to my knowledge repertoire.

    Best,
    Alexa

    1. Thanks so much Alexa. The first book I ever read about pain was by Melzack and Wall “The Challenge of Pain” – and that turned my approach to pain 180 degrees for my own pain. It’s well outdated now, but without it I am certain I’d have been going on the merry-go-round of seeking treatments and fearing the worst for far longer than I’d need to.
      I hope you do get Radical Relief, it’s an excellent book and I’m so happy to have it on my shelf to share with people looking for ways to live with pain.

  2. nice one Bronnie. Ive just started full time with my pain rehab team – rather than a split role with out patient physio so i feel a relief that I can really fully bring my attention to bear on being of service in the relief of suffering for people with persistent pain. It great to have your recommendation for this book as the main theoretical framework we use is ACT or at least thats what our team lead is always pushing having worked with Lance McCraken for some years. Keep doing it Bronnie.
    Much appreciated
    Lloyd

    1. Hi Lloyd and congratulations on your new appointment! Yes, I really like this book, it’s so clear and simple and doesn’t have the jargon that some books have. There’s a small section on neurobiology but quite rightly, the emphasis is far more on doing and experiencing something different. Let me know if there are any topics you think I should write about this year! My focus will be on teamwork in all its variants as I write a new book chapter for the textbook Pain: A textbook for health professionals (3rd edition).

      1. Nice one Bronnie, Ive just yesterday requested a copy of the 2nd edition on researchgate. I consider a significant part of my role or interest/passion is supporting team cohesion and wellbeing so I guess that will be there as well as effectiveness so I look forward to that. If anything else comes up I’ll let you know.

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