It’s disabling persistent pain experienced that then opens people up to shift their cognitive thinking. In addition to his teaching and research at Curtin University, he works in clinical practice as a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2005) in Perth, Australia. As physios, we’re very into the movement aspect of things and we should be. We didn’t know what to call it because there are elements. When you look at movement as a behavior versus movement as a science, it changes a whole lot of things for people. It’s influenced by each stuff including those things we touched on. Let’s talk about back pain first. First is the exploration of the person’s story where we would capture the story, the contextual factors around their pain, their beliefs. It has this very powerful ability to influence behavior. In this inaugural episode of season 1, we chat, from a distance of course during the Coronavirus pandemic, with Professor Peter O’Sullivan from Curtin University and Body Logic Physiotherapy. Dr. O’Sullivan shares his journey from clinician to researcher and educator, how his research and study into back pain physiotherapy and behavioral psychology has changed his own belief system, treatment approach, and practice in treating chronic low back pain. If you have someone who has this fear of bending, for example, and you get them to stop. We’re going to talk about some of that factor. It gave me time to reflect. I designed a course and marketed it through the Birmingham Chamber of Commerce where I made lots of useful contacts and provided several companies with in-house training. There is an industry that feeds off within that. Receive free training and the latest episode right to your inbox. It seems so simple yet it’s so profound. These people are pretty well, but they’re not coming to us because they have bounced out of that care and are sitting in painful aches and orthopedic wards. What is high value care and what are the barriers to delivering it? We examine them through an exposure process then we sit down and we say, “This is how I see your story.” I see it a bit like someone brings a jigsaw puzzle to you with all the pieces, but have lost what the picture looks like. O'Sullivan, K., L. O'Sullivan, A. Campbell, P. O'Sullivan, and W. Dankaerts. What you’re saying is that in probably 95% of the cases, there’s not a single pathoanatomical cause that can be identified? I love the way that sounds. I’ve been excited to talk to you. It’s a wonderful perspective paper on not only low back pain but also Cognitive Functional Therapy, which is something that Peter has been working on. Contextual factors, early life experiences and how you respond to it will be massively informed by your coping responses. That’s the stuff that is the goal that sustains me in practice. It’s almost like from early life, we set up these rule-governed behaviors that, “If I have pain, I cannot go to work. He was highly fearful and sensitized around that but very guarded in the way he did it. That’s the embodiment of how they see their problem. It’s like you’re disarming them before you expose them. In addition to his teaching and research, he works in clinical practice as a physiotherapist. Joe discusses chronic low back pain with Dr. Peter O’Sullivan, PT, PhD. We would suggest that the reason for that is that if you’re not managing that person sensitively and carefully and they don’t trust you. Sit up straight go and say, “Don’t bend your back when you lift. It’s good for your health, your cardiovascular health, your bone health, etc. I’m only one small cog in a much bigger engine and I’ve been incredibly fortunate to work with some wonderful people both here in Australia and internationally. If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at support@drjoetatta.com. I hear a little bit of the behavioral psychology, ACT, CBT, motivational intervening. Changing perspective is so important when it comes to pain. These are life trajectories that emerge probably early in life and they set the course. It’s huge. I was fortunate to be at a fantastic conference in Sweden with Steven Linton and Michelle Craske who is an expert in anxiety, particularly phobias and fear. When you expose someone to movement, when you’re challenging those moving hands, are you looking for a sympathetic arousal in them? To me, that’s a whole area that needs to be embedded in terms of training. Share this information out with your friends and family on Facebook, on LinkedIn, on Twitter. It’s obviously not often not well regulated. It doesn’t limit me. The evidence is emerging. That person is frightened. You call it cognitive flexibility. That taps into this idea of cognitive flexibility where you can look at a problem and shift your thinking and adapt your life around it. I’ve had dozens of various injuries in my life. I personally have a problem with that. There are so many things that influence those factors. You realize that that’s why these beliefs are so strongly embedded. Through a graded exposure process, while we got him to desist from his protective behaviors. As a team, we’re stronger but this work is not about me. The exposure literature around back pain would suggest that it doesn’t work for everybody. After a weekend course, what’s the next step towards clinical growth? I think of a chap that I saw who was disabled. In terms of teenagers, you can identify these beliefs and they’re linked to behaviors. I’ve certainly been very fortunate. Here in the United States, we have whole institutions created around a biomedical model. Funny thing was, heading into it I thought I was going to be the wrong kind of patient because I know too much about pain science (ha! Learning to communicate well with other human beings is so important. As a society, more sedentary, more sleep-deprived, and unhealthy in terms of diet. Prof O'Sullivan sat back - almost supine in fact, in his chair - and revealed a clinician at the height of his powers. There’s this whole manifestation of someone’s beliefs and emotions in terms of the way they move. Let’s first talk about positive beliefs, can we talk about that? If you followed my research career, a lot of it is testing hypotheses, which fundamentally tested my belief system, the stuff that I’ve been taught as a PT. We see that there’s an absolute need in the health environment to create another narrative around managing pain in a way that empowers people to take control of their health rather than being a passive recipient of a pretty average health. Those life situations are tough. It was interesting having this discussion around exposure as very effective for the phobias. Often those messages that are promoted out there, create a lot of vulnerabilities for people. He completed later his post graduate manipulative training in Australia. Prof. Peter O’Sullivan is recognised as a leading clinician, researcher and educator in the management of musculoskeletal pain. He was the BBC's leading horse racing commentator from 1947 to 1997, during which time he described some of the greatest moments in the history of the Grand National. For spiders, it’s effective unless you’re bitten by the spider. SIVUH South Infirmary Victoria University Hospital, Cork, Ireland. I want to extend a little bit of gratitude. Where people fail to respond to primary care, they rapidly escalate into these risky interventions like taking opioids and having injections and implants in the spine. A lot of his work is more on researching how lifestyle affects pain. In that paper, Peter, you talk about protective or resilience factors, which I love the terminology because so often we’re focusing on what could potentially be wrong versus what can we do to build ourselves up, make ourselves resilient. ... makes each course interesting (I mean our final project is making a short horror movie). That’s being part of my journey, but we could save people a heartache by shifting their focus towards areas that probably going to be much more fruitful in terms of their practice. People who do very little have an increased risk in terms of pain. That was a critical shift in terms of my practice to allow the people I worked with to become teachers. It doesn’t bother me. Overview This course is not Online and will require attendance for 8 days in Perth, Australia. It’s influenced by a health literacy. We have to learn more about human behavior. What are the factors that help protect our spine and protect us from persistent pain? The time we spend with patients is not only critical for the patient, but I also think it’s critical for us in our profession. For others, it’s slower. It’s about a much bigger picture and a group of people. If their pain ramps up and their distress increases, you’ve reinforced fear learning. This constant updating of my belief system and then adapting that in terms of a change in practice and part of that as well is this massive increase in understanding of pain neuroscience and behavioral psychology, which married so beautifully in the pain space. You relax them. I think because a health care practitioner to have a repetitive dose of pain in my life. They can start to move. Unraveling I suppose the complexity of the pain that we see in the people that we come across. I talk about lifestyle a lot. The model that was proposed a number of years back by Leventhal was called the Common Sense Model of understanding health illness perceptions. The first part of your CFT intervention or one of probably the parts where you start is something you call making sense of pain. The former Welsh international – he played three matches, two against Scotland and one against Malta scored over 40 goals while with the Albion in his position as a raiding left-winger. Peter O'Sullivan. What we see with CFT and the reason we call it FT is the F bit, the behavioral aspect seemed to be very important as we embody pain in their bodies. Pain is such a powerful learning. All the clinical signs came back that we thought were related to unstable pelvises. You’ve got some great research and clinical work that you do. We’re trying to dampen that. That movement is safe and healthy if you have back pain. For others, it might be a slower journey and for some, their beliefs will change fast. We would believe that how you go about exposure can either reinforce fear learning or safety learning. We have to be good at doing that. Having that understanding shifts the way you look at pain. You often have a sense of disbelief because they’re expecting pain. Often therapies and advice to people to reinforce that. (for a review of the whole workshop, check out Diane Jacob’s post.) It’s hard for those people to care for themselves well in terms of their lifestyle because there are so many factors that are working against them. Let’s set the stage as far as back pain goes. They’ll bounce in and out of healthcare without being adequately managed. Pain is something and how we respond to pain is something we learn really early in life and that’s formed by the culture around pain in a family situation. Be prepared to hear a different story. He is recognized internationally as a leading clinician, researcher and educator in the management of complex musculoskeletal pain disorders. One of the things that we see in the current health climate is that we’ve got PTs on one side who will tend to be more structural and biomechanical. All the things that you and I have been talking about are things that are modifiable. He is well known internationally as a clinician, researcher and professor of musculoskeletal pain disorders. All Rights Reserved. We look where do you start intervening with this stuff? You’ve got to be such a cool, calm person, who holds that person en route, gives them confidence, talks to them calmly. A technical question as far as exposure goes because when the word exposure is like Kleenex. That’s explained through other processes. It looks like it has an effect for people with both moderate and those who are pretty disabled. This makes sense.” That’s why it’s not a typical pain education session. Peter, welcome to the show. If you’re edgy, uncertain and a bit erratic that will freak out. I feel sad when I see very poor judgmental comments that come out of social media around it’s just about what you ate, which highlight that people don’t understand the complexity of human behavior. How his research and study into back pain physiotherapy and behavioral psychology has changed his own belief system, treatment approach, and practice in treating chronic low back pain. With pain, it’s very interesting because things like beliefs seemed to be important. View Peter O'Sullivan’s profile on LinkedIn, the world's largest professional community. Tremendous points because exposure sounds great and you get into it. In her work, she says you have to expose people to about 30-second increments and she’s mostly talking about anxiety. I see that we need to extend the scope of practice to adequately deal with the people who need that care. A short (10 minute) video where 2 clinicians discuss their experience using CFT in clinical practice with Peter O’Sullivan. That doesn’t sit well with me. It’s a delicate thing that most people probably glance over. Prof. Peter O’Sullivan is professor of Musculoskeletal Physiotherapy at Curtin University, Perth, and is one of the most influential and innovative names in the specialty, that is back pain. A history and political science graduate of Saint Anselm College, Peter O’Sullivan has worked at leading technology companies based in Silicon Valley, San Francisco including as a category lead of technology at Facebook. It’s helpful as a practitioner. To calmly sit with someone while they have a panic attack is an important thing to learn to do when you’re doing exposure work. It’s funny I interviewed Jo Nijs, who is a great PT and researcher around that. One of the things that interest us is that everyone’s journey is quite different. I reckon it’s exactly like that with dealing with people in pain with exposure. That’s a little bit different in your perspective. We have a curriculum that’s full of stuff and a lot of it is stuff that’s probably not that helpful. I realized that we didn’t have much understanding in terms of research as to what was happening. Your body language will dictate how that person responds. Resilience is an interesting area. They’ve got a mom with Alzheimer’s at home and working X number of hours to pay for a mortgage. The work you have is critical not only for the physiotherapy profession, but I’ll spill over into other professions and it helps a lot of people. If you want to sample some of Peter O’Sullivan’s work, if you go to the Physical Therapy Journal and look up Cognitive Functional Therapy and integrative behavioral approach for the targeted management of disabling low back pain. That’s a lovely paper that shows that everyone’s journey looks quite different. We hosted Peter O’Sullivan and discussed: Peter’s journey and the importance of supportive colleagues with shared values. We’ve done research looking at some young people from early life and those beliefs emerge early in life. The lifestyle is such an interesting area because it’s influenced by so many things. I can think of the hundreds of hours that I’ve spent in my career learning stuff that I don’t value anymore. We’ve got a massive problem in our society because we don’t have a lot of interventions that are showing to have much effect. I’ve spent an hour with every new patient. We published a paper showing that if a young person is taking time out of school because of their back pain, 70 years later, that’s significantly more likely to take time out of work for their back pain. It didn’t sit well with me in a lot of ways. How to effectively use Exposure Therapy for people with pain and finally, how to make sense of pain whether you’re a practitioner or a patient. The other things that give a great sense of satisfaction is that you’re doing good for people. People with positive beliefs around back pain are less likely to seek care. They’re not driven and the society would certainly play a role. If I have pain, I cannot go to school.”. 2012. " He is recognized internationally as a leading clinician, researcher, and educator in the management of complex musculoskeletal pain disorders. A lot of explaining pain that has done so well for people provides them with a different perspective as to what their pain is and what the possibility is even if they have a little bit of pain in their life going forward. I attended Rey Allen’s course on DermoNeuroModulating (DNM) in Boulder, Colorado last month and have been processing all that I learned and experienced there, with much more processing to do. All of those factors can be factors around risk. Peter O ' Sullivan Introduction For many, spinal pain first develops during adolescence. To your point, if you’re not good at managing that entire experience, it can go wrong. I ended up getting to Australia and doing my postgraduate on Manual Therapy Training in Perth, Western Australia. It’s like you’re sweating more than the patient is. There are people with stress reactions of the bones that don’t have pain and others do have pain. Through all of the doctors and therapists I saw over the years, not one had ever asked for my story. It’s something that physios tackle globally, which probably could be a PhD or/another podcast in and of itself.

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