There Is Hope Out There”: Katie Rothwell on CRPS, Pain Science and the B.E.A.T Pain Approach

" I found that massage and hands on therapy helped but nothing worked long term until I started to learn about pain and thus fear it less. "

Katie Rothwell is a chronic pain specialist based in Shropshire and the founder of the B.E.A.T Pain approach — a framework built around education, nutrition, exercise and therapy that draws on the latest pain neuroscience. Having suffered debilitating back pain herself, Katie spent 14 years studying what actually reduces chronic pain rather than simply managing it. She has previously delivered webinars for Burning Nights and we recently caught up with her to talk about CRPS, the state of pain treatment in the NHS, and why she believes recovery is possible.

1. Would you like to start by giving a little background on who you are, and how you came to set up your clinic and develop the B.E.A.T Pain approach?

I’ve always loved studying and understanding the human body and actually wanted to be a physiotherapist growing up, but ended up studying Physiology and sports science at University.  However, it wasn’t until I suffered awful back pain that I really started to pay attention to pain and understand what causes pain and what indeed reduces pain.  I found that massage and hands on therapy helped but nothing worked long term until I started to learn about pain and thus fear it less.  I have now spent the last 14 years studying pain both for myself and for my clients and everything I have learned I have condensed into an easy to understand way in the BEAT pain approach.

2. You've previously been involved with Burning Nights through a couple of webinars — how did that connection first come about?

Yes I was asked to do a Webinar for Burning Nights through a connection with Healthsec Rehab - a local physio clinic near Shrewsbury.  They had been asked by Burning Nights to run a series of Webinars for Burning Nights and as I’m a subject matter expert in Chronic Pain they asked me to deliver one of them.  

3. For anyone who wasn't able to attend, what were those webinars covering, and what did you hope people would take away?

I delivered the one about using the traffic light system to explain your rate of pain to others on a daily basis and also the concept of the pain passport.  When you are in pain, having to constantly explain your symptoms and your rate of pain is not only exhausting but it also forces you to focus on your pain and you do become hyper vigilant to your pain. You can make it worse because this contributes to fear which dials up pain.  So the idea of the traffic light system and the pain passport is to take away the need to constantly explain your pain to others. You can read more about preparing for pain appointments on the Burning Nights website.

4. CRPS is more common than many people realise — you mentioned that a friend developed it following a netball injury. How do you feel the NHS is currently approaching chronic pain conditions like CRPS, and where do you see the biggest gaps?

Yes, CRPS and chronic pain in general is very common sadly.  I believe that CRPS often follows an injury such as with my friend following a netball injury whereas other forms of chronic pain can just start gradually.  Whilst the NHS and those serving in the NHS have the very best of intentions they don’t actually understand chronic pain as chronic pain is very different to acute pain.  Doctors for example are only taught about 18 hours of pain education in their training and this covers things like what drugs to administer and what interventions to recommend (Source: The Painful Truth by Monty Lyman).  The new science emerging around chronic pain has not yet filtered into mainstream medicine which is hugely frustrating because it means that those suffering are often told things like “there is nothing more we can do” or “you will have to learn to live with it” which is hugely demoralising if you are the one suffering.  There is hope out there and it's in the form of pain education and rewiring the nervous system.  It is important though to seek help through the doctors and NHS initially though as it is important to rule out anything really sinister. Once this is ruled out then seek help from someone trained in chronic pain specifically.

5. How do you feel about the term "pain management" itself — is it a helpful frame, or does it come with baggage?

I hate the term “Pain Management” apart from the fact that many clients come to me having tried pain management in the NHS and it's failed them, so there is a negative feeling there towards the term because of that.  Pain management leads us to believe that we have to manage our pain/symptoms or learn to live with it, but I like to be more hopeful than that and believe that we can fully recover from it.  I went to a conference recently called “Living Well with Pain”.  Again I like to think we don’t have to live with it, we can get rid of it and get our lives back.  There are many many recovery stories out there now on various platforms or websites proving that we can get rid of it.  However, I must also add that pain is something that makes us human and is our protector, so whilst you may recover from the current symptoms, other symptoms might crop up but having an awareness of the body and of pain we listen to these symptoms in a different way and therefore they don’t continue and don’t escalate. 

6. There’s a growing conversation in pain science about how little time medical training dedicates to understanding pain — research from the British Pain Society suggests that even where pain teaching is dedicated and compulsory, just 0.2% of undergraduate medical teaching is allocated to pain. Why do you think chronic pain has historically been under-explored, and do you think that’s changing?

Why has chronic pain been under explored? One reason is because chronic pain is notoriously hard to study.  Unlike a broken bone or an infection, pain is subjective - there often isn’t a clear blood test, scan or visible injury to measure the extent of someone's suffering.  With the advancement of brain imaging such as functional MRI, this is helping researchers better understand how chronic pain works.  Chronic pain involves completely different parts of the brain in comparison to acute pain.  Chronic pain lights up emotional centres of the brain.  This has helped to shift the understanding of pain = tissue damage to recognising it as a complex nervous system process.  We are also seeing a shift towards neuroplasticity, stress physiology, emotions and the nervous system’s role in persistent pain.  A lot of this work is spearheaded by Doctors in the USA such as Dr Howard Schubiner and others. I would also add that chronic pain research has historically received far less funding and attention than areas such as pharmaceuticals.  There’s often more financial incentive in developing medications than in studying the wider biopsychosocial aspects of pain recovery.  However, awareness is definitely increasing and someone at that Living Well with pain conference that I attended, asked the question to one of the doctors presenting “Is the NHS moving in the right direction?” To which his response was “Yes, but at a glacial rate”.

7. Living with CRPS affects far more than the physical — it can reshape someone's sense of identity and take a real toll on mental health. How much does that emotional layer come into your work, and how do you approach it?

Yes, pain can absolutely change one's identity - it did mine! In my BEAT Pain approach I start by explaining the pain science and teaching ways we can rewire the nervous system.  Then we look at the emotional component because often we have suppressed emotions even on an unconscious level and this could be contributing to our pain. This is the harder layer to get to so I either use my craniosacral sacral therapy skills in Somatic Emotional Release or I use somatic tracking along with some other resources to gain understanding of the meaning of our emotions.

8. Burning Nights features a number of self-management tools for its readers, including Spoon Theory & Mirror therapy — the idea of rationing energy across the day. What techniques have you drawn on or recommended for people trying to navigate daily life with chronic pain?

I’m a big believer in using analogies to explain concepts and this helps clients put them into practice because the understanding is there.  There is no point asking someone to meditate if they don’t understand why!  I teach somatic tracking, I have some meditation recordings, recipes to reduce inflammation, and I teach journaling - emotive writing amongst other things.

9. If someone has just received a CRPS diagnosis and doesn't know where to turn, what would your first piece of advice be?

Check out some of the many free websites such as yours, Flippinpain.co.uk, SIRPA.org, Livingproof.org where they share some pain education and some stories of hope.  There are also many podcasts out there sharing information on this and the ones I like are Nicole Sachs — The Cure for Chronic Pain, Dr David Clarke — The Story Behind the Symptoms, and Dr Howard Schubiner’s podcast The Science Behind the Symptoms.  And of course there is my website where I have the wellness hub full of free resources and blogs - https://katierothwell.co.uk/wellness-hub/ 

10. For someone who has been living with CRPS for a long time and feels like they've exhausted every option — what would you want them to know?

You have to have hope.  Hope is the first ingredient to getting better.  You have to believe you can get better because the brain seeks information to support its belief.  This is why I love listening to stories of hope.  Also don’t try too hard to recover! I know this sounds counterintuitive but we can end up applying too much pressure to recover and this is perceived as another threat by the nervous system.  It's what we call outcome dependance.  We want to be doing all the kind things for ourselves and be outcome independent - this goes alongside reducing our vigilance of our pain.

If you would like to know more about the BEAT Pain Approach or contact me for further advice then please check out my website. www.katierothwell.co.uk

Sources: 

• The Painful Truth by Monty Lyman
• “Even where pain teaching is dedicated and compulsory, only 0.2% of undergraduate medical teaching is allocated to pain.” British Pain Society