Pain, is it what you think?
We take a bio-psycho-social approach to pain management, meaning that we don’t just look and work with your physical pain. We work with you as a complete person, and so we also consider the psychological and social aspects of your chronic pain.
The bio-psycho-social model of pain is a way of understanding pain that takes into account the interaction of biological, psychological, and social factors.
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1. Biological
This aspect considers the physical aspects of pain, such as injury or inflammation. It involves understanding how the body's tissues and nerves may contribute to our experience of pain.
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2. Psychological
Pain is a physical and emotional sensation; it can also be influenced by our thoughts, and behaviours. Psychological factors, such as stress, anxiety or depression can amplify the sensation of pain, and prevent recovery
3. Social
Our social environment plays a role in how we perceive and cope with pain. Cultural, family, work and societal influences can impact our experience of pain and our ability to recover.
How long I have Struggled with Pain, and Why it Matters.
Pain is best defined by how long we have experienced it, and not defined by how severe it actually is. The terms acute, sub-acute, and chronic pain, defines how long the pain has been present. It is important to understand the difference between these three classifications, as three subtypes are not the same and each requires a different approach, although the treatment and advice that is given in routine usual care are often the same.
Acute Pain
Acute pain, is the term used to describe how long we have suffered with pain, not how intense the pain actually is. Acute pain is a signal that the mind and body have detected a threat to bodily safety and we need to act to protect ourselves. The acute pain stage lasts up to six weeks from the point when it started.
Sub-Acute Pain
Sub-acute pain lasts from six to twelve weeks. During this time we find that the pain is creating more interference in our activities of daily living, including sleep. It can start to wear us down and impact on our mood and relationships.
Chronic Pain
Chronic pain describes pain that lasts or recurs for more than twelve weeks. By this stage the tissue has usually healed, but the brain hasn’t turned off the warning
system. Why? Because the brain still believes we are in danger, but the threat may now come from our emotions and thoughts about anything that we are uncertain
about, or feel threatened by, including pain! At this point just dealing with the biological or structural issues is usually insufficient to allow us to fully recover.
The main obstacles to recovery from chronic pain are psychosocial, not biological.
Dr. Nick Penney
PhD (Musculoskeletal Medicine)
Fellow of the Royal Society of Medicine Pain Specialist
I originally trained as an Osteopath at the British School of Osteopathy in the UK in
1980, practicing in the UK and New Zealand. In 1997 I was a member of the group
that created the New Zealand Acute Low Back Pain Clinical Practice Guidelines. We
were the first country in the world to recognize that what is going on in your life can
have a dramatic impact on recovery from low back pain.
I went on to study the biological, psychological, and social factors that contribute to
our experience of pain and act as obstacles to recovery from pain, at The Centre of
National Research on Disability and Rehabilitation Medicine, at the University of
Queensland and graduating with a PhD in Musculoskeletal Medicine in 2009. During
this time, I was also an expert panel member in the Australian evidence-based
clinical practice guidelines group.
2014-2021 I ran a multidisciplinary pain clinic in Auckland which consistently
produced some of the best patient outcomes of any pain service across New
Zealand and Australia.
Now in private practice, I divide my time between Queenstown and Christchurch,
offering a bio-psycho-social approach to pain which includes several diagnostic tools
and a range of techniques to manage acute, sub-acute and chronic pain.
I also teach mindfulness based cognitive therapy, a first line treatment for
depression and chronic pain.
Further information and patient stories can be found at www.mindfulhealth.nz
How Do You Treat Pain?
Our Treatment Approaches for Pain:
Firstly, we need to understand all the many Bio-psycho-social factors that have combined to create the pain, and prevent you from recovering. We then need to create a tailor made individual, stepped care treatment plan. Stepped care means taking as many steps as necessary from your treatment plan in order to recover. The steps include a number of trans-diagnostic, and multi-disciplinary techniques combined into a unique formula for each patient. The steps may include:
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Neuropsychological pain education -understanding the bio-psycho-social factors
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Benson Stanley Relaxation Response Exercise
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Sleep hygiene
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Paced exercise and use of relative rest
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Progressive loading of the injured area so as not to trigger further ‘threat’
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Physical therapy
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Mindfulness based cognitive therapy (MBCT)
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Acceptance commitment therapy (ACT)
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Mindfulness based stress reduction (MBSR)
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Mindfulness for children and adolescents
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Medication optimisation (in conjunction with your GP or medical specialist)
