As a teenage swimmer I had a strong focus on athletic performance. I believed sport required coping with and enduring pain – my favourite saying to my sister, also a swimmer, was “no pain no gain”.  Pain was a gateway to performance, a requirement if I was to achieve more.

Pain was something I could control by putting in more or less effort. I had a sense of mastery over it, but this took a hit when I had my first big injury and was wracked by shoulder pain.

I was so frustrated. I lost control, got worried, believed my hurt meant I was irretrievably  harmed – I was convinced that this injury was something serious. My physio’s images were front and centre in my mind, and I conjured up the classic idea of a “discy neck”, likely due to my days in school rugby. There wasn’t a clear way forward, and without a solution I stopped swimming. Interestingly, the pain did get better, but my confidence took a hit and my linear concept of pain was reinforced. 

Things didn’t improve when, as an adult, I ruptured an Achilles tendon. I got past the early post-surgical phase, but the pain remained. My mind’s eye would fixate on visions of an aged and frayed tendon, sometimes a botched surgery with dodgy stitching. Why else would it still hurt? These experiences reinforced my beliefs about pain as an input and something to be endured. 

At the time, I was working in a pain clinic and also in sports medicine teams with internationally competitive athletes. Conversations with Dave and Lorimer during this period of time showed me that my interpretation of pain was way off from aligning with contemporary pain science. This was true even while the clinical and research work I was doing was all about pain coping and the acceptance of pain. I could see links between what the pain science people were suggesting and what I was doing, but I was still thinking about pain as an input – as a psychologist, I was focussed on helping patients to accept or cope with pain during their journey to recovery. 

Then I was struck with back pain and I began to think that, clearly, my body was over the hill, it was packing it. Of course, I had been learning that activity might play a role in my recovery, so I decided it was time to give this exposure stuff a go. 

I was still experiencing pain when I ran, something vague I could detect around the lower back, so I decided to run into it. As I ran, I felt my pain but did my best to feel it while thinking about the new concepts I’d learned about pain. At this stage, I realised that the pain acceptance skills I was teaching were fine, but the context of the acceptance had shifted. My clinical work had been about helping people to accept their pain without a true awareness that it was not directly related to damage, and now I was beginning to accept the sensations of pain while understanding its protective function. The shift was subtle and personal, but I felt a long way from where I was when I gave up on swimming. 

After this experience, I dived into contemporary pain science literature. With my own history the ideas immediately made more sense and I was able to use concepts more naturally and confidently in my clinical practice. It changed my hopes for my clients, and shifted what I was prepared to work toward with them. And this process is still ongoing. 

Concepts outlined in this book have helped me to further integrate pain science into a cohesive practice model. I feel a greater sense of optimism about recovery, and this has an effect on both me and my clients. 

Now, I see my role as supporting clients to choose types of activities that mean something to them, but also activities that will help them question old beliefs and create mastery experiences. The overarching goal is no longer to endure pain, but to trust the evidence that pain can be modified. Engagement is no longer limited by pain, and communicating this is a potent treatment not just for quality of life but also for the experience of pain.

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John Baranoff is a psychologist who has written about his personal and professional experiences of pain for our new book Permission to Move.