5 MINUTE READ

From Luke’s Journal May 2025 | Vol. 30 No. 1 | MIMBY

One of the joys of General Practice is just that – it’s general.  We get to do a bit of everything.  There is no part of our patient’s lives that we don’t care about.  And we get to walk alongside them through every stage of life, in all its complexity.  This is a lifelong journey full of many special privileges.

My favourite illustration for holistic patient care is the “stable table of health”, incorporating 4 legs representing bio-psycho-socio- and spiritual health. 

This gives me the chance to discuss:

• bio (represented by the 3-legged stool of healthy nutrition, healthy movement and healthy sleep);
• psycho (mental health);
• socio (connectedness with people who matter) and
• spiritual (what gives life meaning and purpose) health.

It’s great that this broad sweep is part of our regular purview.

One of the most common complaints of patients is pain.  Acute pain is often easily diagnosed and dealt with: tissue damage leads to pain, then the body heals, and we support it using analgesia whilst it does its wonderful work. Chronic pain is a completely different kettle of fish. Understanding it is counter-intuitive, and dealing with it requires harnessing the massive healing power of the brain, more recently understood as ‘neuroplasticity’.

Sam Evans, like many authors, has his own chronic pain story which gives his narrative credibility.  His voice is casual and engaging – he’s with you on this journey and he asks the same kinds of questions that you or I might, including the difficult ones.  As an engineer, he is interested in measurable results, and specific steps to get there.  Me too!  And many of our patients would want the same. I was glad that the book is thin, and the process relatively simple and time-limited – ten minutes of writing a day for up to three months is manageable for most people. It was also easy for me to describe the theory and process in a few minutes to patients with chronic pain issues, many of them keen to minimise their dependence on medications. In my own chronic pain journey, I can attest to the astounding benefits of a neuroplastic approach.

The chapter headings are descriptive and sub-headings specific.  For example:

• Determine if this book is a valuable fit for you
  • Neuroplastic pain is real, it hurts, and it can be treated
• • Pain management is hard because you have to figure it out for yourself
• • Effective pain management isn’t luck, you can design for it
  • Where you might be coming from, and how this book can help you
• Writing reduces the severity of neuroplastic symptoms
• Somatic tracking is the high-impact method of treating neuroplastic pain

Each chapter ends with a short summary of the takeaway messages from the chapter, and includes some questions to ask about the reader’s own situation. Sam is also specific about who the book isn’t for: those with clear, acute tissue damage (eg. broken bones, surgery, infections, cancer-related pain, nerve damage or sprains).

Evans’ book is realistic in its expectations, and specific about how to do it.  He helps to reframe our understanding of chronic pain:

“Pain is an experience, and we can reduce and even stop long-term neuroplastic pain sensations.”

“Neuroplastic pain is a reversible brain-generated phenomenon.  What this means for you is that “something is wrong with my back” becomes “something is wrong with how my brain experiences pain”.

Sam describes normal physical reactions at times of emotional stress to demonstrate the mind-body relationship in daily life, and to give the reader an insight into how chronic pain pathways are laid. He gives specific instructions and then reminds us that we typically see the most benefit after a period of dedicated, incremental practice.  He also encourages the reader to collaborate with medical health professionals for adequate safety-netting and whole-person care.

The pared-down process for addressing neuroplastic pain that Evans describes is:

1. Emotional expression and awareness through writing
2. Preventing and reducing neuroplastic symptom triggers
3. Use somatic tracking on remaining pain sensations.

He gives specific questions to address and reflect on, broken into different groups: when you first noticed your pain, your physical reactions, your environment, your personality, your social circumstances, your beliefs about pain, and tangible counter-evidence. These specifics make the writing task much more directed. Mastering the above steps is like any new skill – difficult and clumsy at the start, and easier and more effective as you practise a little bit every day – much like learning to drive or improving at a video game.

Evans is keen to use small quick wins to level up so that people know that they are on the right track and encourages celebrating each small victory as part of the process.  He is also realistic about dealing with setbacks. Although Sam doesn’t profess his Christian faith in Past Pain, the book is an expression of care that springs out of his love for others, an expression of God’s common grace. 

As health professionals seek to care holistically for our patients, this is a practical and affordable tool for the many people we treat with chronic pain. You can find Past Pain on Kindle for $12, or buy a hard copy for $35 on Amazon.

Past Pain: Recognizing, Resolving, and Reversing Neuroplastic Pain
by Sam Evans
ISBN-13: ‎ 978-1763668102
Get Past Pain (26 September 2024)

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