Anyone suffering with chronic pain or treating or caring for someone with chronic pain will be relieved to discover that MINDSET isn’t a just a state of mind, but an acronym for 7 steps to help with recovery. It is the work of Dr Deepak Ravindran, a pain specialist whose journey alongside thousands of patients with chronic pain has given him the confidence to wrap what he has learned into a practical and largely accessible 7 steps for taking control and overcoming chronic pain.
MINDSET stands for: Medication, Interventions, Neuroscience (and stress response), Diet, Sleep, Exercise (and movement) and Therapies (of the mind and body).
The Pain-Free Mindset is a workbook filled with suggestions for making progress in every one of the 7 steps which can be DIY (Do It Yourself), DWY (Done With You aka ‘supported self-management’) or less frequently DFN (Done For You). Reading the book isn’t going to relieve your pain, but returning to it over and again and working on the 7 steps will undoubtably help you make progress. Patients and clinicians frequently feel stuck when trying to cope with chronic pain and the beauty of this book is that you can either work at the area you’re stuck with or focus on another step that’s been overlooked or is more easily achievable. Sceptical readers might quibble at the alternative therapies included but would do well to remember they’re included as part of an overall package of care and not promoted as cures.
One thing that perpetuates chronic pain is inconsistent and unhelpful advice from professionals and this book includes several accounts of patients who were poorly advised by doctors promising a simple explanation or solution to their chronic pain. Much as we might want pain to be a simple matter or for a pill or a procedure to make our lives less painful, the truth is that coping with pain requires attention to every aspect of our lives – or all 7 MINDSET steps.
What stands out by omission is that pain is a social justice issue – social exclusion by poverty, gender, race, trauma, disability, imprisonment etc. vastly increase your risk of suffering with chronic pain. The more ways in which people are disadvantaged the more likely they are to suffer pain and the harder it will be for them to follow the 7 steps. My own (White, middle-class, professional) lifestyle measures up pretty well to Dr Ravindran’s 7 steps, and I’m sure his does as well. It’s a healthy lifestyle for everyone to aspire to, not just people with chronic pain. You might as well say, ‘Don’t be poor, have supportive friends, have time to cook and live near safe, green spaces.’ I work in an urban practice with high levels of poor housing, airborne pollution, food-bank dependence and social isolation where chronic pain is as prevalent as asthma and diabetes. People’s choices are constrained by their circumstances.
I’m not nihilistic about chronic pain, far from it, and both Dr Ravindran and I have over 30 combined years of working with the same patients and have seen enough of them improve to know that people do get better, even in deprived areas. But very often what’s required is a change in circumstances beyond the control of the doctor or the patient – for example, a violent partner leaves or they start a satisfying job with a living wage.
That said, if you’re feeling ‘stuck’ with chronic pain and want a better understanding of how mind and body interact to determine how we experience pain and what we can do about it, then this is a great book that is full of ideas for progress that I have no hesitation in recommending to patients and it will be their feedback that I’m especially interested to hear.
A Better NHS 