Hi Niknak, I have done a cut and paste of the text from the article. – Obviously its an article to sell a book he has published, but we all now know that the CICO model promoted by western medical advisors is incorrect. So when he says pain management is incorrect because it fails to consider diet and inflammation, and feeling in control – I start to see the links.
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“That pain you are feeling, that continuing dodgy back, oof those knees, the flare-up of that old injury, the it-all-hurts that sends so many millions of people hobbling in and out of GP surgeries and hospitals for lifetimes: it’s not what you think. It’s in your brain.
I’m going to pause for a moment to hide from assault. People in pain are like wounded animals, and nothing gets them more vicious than anyone saying, even hinting, that they are doing their suffering wrong. So let me quickly introduce you to Nick Potter, an osteopath of three decades. He’s the Mr Fixit who such big names as Elton John, Michael McIntyre and Samantha Cameron, as well as many elite athletes, call when they can’t get out of bed.
His new book, The Meaning of Pain, doesn’t just say that people are doing their pain wrong, but that the whole of western medicine is doing pain wrong. At present, 43 per cent of adults live with persistent pain, suggests a BMJ study. A lot of that is backs: back pain is the leading cause of disability with 30 million working days lost to it a year. It costs the UK economy about £12 billion annually, with £1.6 billion of that spent on treatment, much of it not very good.
“In the UK, pain costs the state more than cancer and diabetes combined, but no one is really talking about it or coming up with answers to treat it,” Potter writes.
The reason is this: we don’t understand chronic pain. Surgery and drugs are the mainstays of the medical establishment, but both have surprisingly poor outcomes. The landscape is ripe for a revolution and Potter would style himself as that revolutionary.
He’s tall with a shock of blond hair that has him sometimes mistaken for Julian Assange. It’s towards the end of our conversation, when he mentions Jordan Peterson, the Canadian academic and self-help guru, that I realise he is the Jordan Peterson of osteopaths, mixing polemic and academic studies to startling effect.
Outspoken, provocative and prone to using words such as “fat” and “lazy”, he would thrive as a talk radio host. I could write a whole other piece on his theories of why women feel pain more than men. Yes, pipe down about childbirth, ladies, it’s true. Yet his radical core message is based on the latest neurological research. We need to use it to tackle the “silent epidemic” of pain that is growing year on year. One study found that the incidence of chronic back pain more than doubled in the 14 years up to 2006.
“If you say your pain is in your mind, or your head, or it’s all psychological, people think you mean they are making it up. It isn’t, and they aren’t. I’m very careful: I say pain is in the brain.”
This is what he means. If you break your arm, your bones should heal within months. That is why chronic pain is defined as pain beyond three months, when we are in mysterious realms. Sufferers are stuck in what he calls the “fish pond of pain”, plucked out by one specialist after another and thrown back in again. The drugs don’t work. Well, they help for a bit, but we all know about opiate addiction — and after you’ve been weaned off them, you are more sensitised to pain than ever. It’s what he calls “the double bitch of opiates; it’s brutal”. As for the buzz about cannabis, “There’s no good evidence yet that cannabinoids help pain at all. It’s bollocks.
“I won’t treat somebody if they smoke dope because it’s a withdrawal drug. It means you opt out, you won’t take responsibility for what you need to move forward.”
Don’t get him started on surgery. Potter says it has a role in a tiny number of cases, but again the evidence is surprisingly weak. A landmark study of surgery for osteoarthritis of the knee, published in the New England Journal of Medicine in 2002, found that it was no better than placebo surgery for pain relief; a 2017 review in the journal Pain Medicine found the same for four different skeletal surgeries. “Spinal fusion operations do not work,” Potter concludes. He recommends Crooked, a gripping take-down of the back pain industry by the investigative reporter Cathryn Jakobson Ramin. It is important for me to point out that his profession, osteopathy, also has a rather limited evidence-base.
He was training to be a doctor, but an accident on the rugby field in which he broke his back led him to quit his degree and devote himself to pain. “How much training do you think your average doctor gets on pain? This is scary. I can tell you because I’ve just spoken to a newly qualified doctor, and it’s exactly the same thing as when I was training. It’s an hour. It’s usually on giving out opiates.
“I spend my life in team meetings pulling surgeons off patients — ‘Oi, you, back off!’ ” he shouts. He sounds unpopular with surgeons. “They are ballsy enough to tell me, ‘I know I’ll do one level [of spinal surgery]. She’ll be back in two years for the next level.’ In the private sector that’s an incentive. The last person to take a first look at your back problem is a surgeon.” He makes a sign of sharpening knives like a person about to carve the Christmas turkey.
Instead, his book draws on the latest neurological research, showing that once you have had pain, it can become burnt into your neural pathways. Your nerves can torture you by misfiring pain signals. It is what he calls a “software”, rather than hardware, problem. And you are more likely to suffer if you have three other conditions: psychological stress, inflammatory problems (often caused by obesity, poor diet and stress) and weak muscles. To truly get better you need to work on some or all of them — and when he says work, he means make a significant commitment, not the desultory bit of physio that most people do.
He is a convert to the theory extolled by the psychiatrist Edward Bullamore in his book The Inflamed Mind, that practitioners need to break a vicious circle of stress and inflammatory that causes pain of body and mind. Our sedentary, harassed lives are not the place to do it.
“The real problem is that most of us are lazy,” he writes. “I know that sounds harsh, but it’s true. Most of us know we do not look after ourselves. We wait for something to happen and react rather than being proactive. Anyone in the world of physical medicine will tell you that getting patients to do what you tell them is the most difficult thing to achieve.”
How does he, who prides himself on telling patients he never wants to see them again, do it? “As I’ve got older, I’ve got quite punchy with patients: ‘Do it or don’t come back.’ When you threaten to sack them, they 100 per cent engage. If they don’t, I haven’t got the time to spend with them and I can’t bear to see them torture themselves.”
Given that pain is such a great problem, why is there not a network of pain clinics? “There should be. That’s the point. When people start getting it, if they do, it will cause a huge social change in how we see pain. You are in as much pain as you say you are. I am not doubting you, I do not think you’re bonkers, but I need you to rethink how you see your pain. That’s why we need the specialist multidisciplinary centres. They are not expensive to run and they would offload the GPs.”
He would like to see rapid referrals to such a centre, giving access to a psychologist — a “really good physical medicine specialist” who would help people to recondition their body — and a doctor who is expert in inflammatory processes such as rheumatism. Compare that to the reality. “With back pain and the NHS, you could wait 18 months before you are seen. By which time you haven’t gone to work. You’re institutionalised into medication, you’re overweight, you’re deconditioned, depressed.”
Fat is a “huge” problem for two reasons: it strains the joints and increases inflammation. “I really do pride myself on being a very kind person,” he says. “I love helping people, particularly fat people actually, because I have been fat.”
He tells patients not to underestimate the importance of losing weight if they want to get better, “not because you’re heavy, but because of the effect fat has on the body”. It is estimated, he says, that there is a 17 per cent reduction in pain for every 4kg lost. That can be life-changing for people who are seriously overweight. Slimming, he says, is “an entirely natural form of pain relief”.
Mental stress is another problem. Numerous studies have found pain worse when people are asked to think distressing thoughts — he has seen a spike in the number of patients since the Brexit vote, all of them worried about their mortgages and jobs. “Do you know why? Because of lack of control and they make that very clear.”
What about Theresa May’s risk of illness? “Oh I think Theresa May is teetering on the brink at any stage. She’s a very high stroke risk, I mean look at her, God bless her.”
He is not the typical osteopath, I say. In fact, his character type seems to have more in common with those strong-headed surgeons he likes to cross swords with. “Maybe it’s because I’m a judge’s son. Truth was big in our house.” He quotes George Orwell, who said that liberty is “the right to tell people what they do not want to hear”. What would he say to the nation if he could?
“The NHS needs you. It’s a wonderful institution. You seriously undervalue it and if you continue the way it’s going to go, you are going to break it.” By doing what? “Not taking responsibility for your own outcome. Doing the small things that can help. I know it sounds very right-wing, and I couldn’t be less right-wing. I’m just a realist.”
The Meaning of Pain: What It Is, Why We Feel It, and How to Overcome It by Nick Potter is published by Short Books, £12.99