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Climate change and persistent pain

By Hayley Leake Physio world 07 Dec 2016


We often receive letters from hard-working clinicians and pain sufferers on their journeys. Recently, we were sent this lovely reflection by a clinician Dianna Howell that we wanted to share.


“This week, I have had the opportunity to re-acquaint myself with one of Australia’s leading Climate Scientists. Whilst undertaking an initial assessment to get the details of a recent injury, we visited the subject of her work.

She told me tearfully that it has been extremely difficult. She spends many hours attending meetings, conferences and media events all over the world attempting to educate people on the pending climate catastrophy. She told me about her fatigue and growing disillusionment and how difficult it is to keep going in the face of so much ambivalence by governments for anything to be different and take any action.

It was not until later that I reflected on this further. Working as a clinician in the area of persistent pain, my experience is not unlike her experience. In fact, I would go so far as to say that our efforts to integrate pain science and pain education/ rehabilitation approach into mainstream medical and societal acceptance is facing similar challenges. We know the science, we know that by implementing a educative and enablement approach that people with pain can live better lives and even recover.

Every day I engage with doctors, surgeons, insurers, rehab providers where I am having to educate and reason with them about the benefits of a different (pain education) approach with considerable effort and often resistance. Closer to the end of my career than the beginning, I hope that things will be different for clinicians working in the area of pain in the future. As I hope for a groundswell of action on climate change. The crusade continues.”


Dianna’s letter resonated with me, as I’m sure it would with many others. The frustration of slow uptake of pain education in the medical community and society as a whole, can sometimes wear on you, even when your individual clients are making progress in leaps and bounds.


Do you relate to this slow and at times frustrating progression? How do you maintain positivity and gusto during these times?


– Hayey Leake

Dianna Howell is a physiotherapist and co-director of Active Recovery in Canberra, Australia. Over her 30 years as a practising clinician she has experienced the necessity to progress in line with evidence based practice and neuroscience. When she’s not in the clinic, you’ll likely find her cheering on the Wallabies (much to the astonishment of her New Zealand hometown friends). 



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  1. Hi Hayley,

    Yes, but I try and have fun along the way and doing what you are passionate about usually helps too.

    A good recent article (Barrett et al 2015. Free-text link with reference below) provides a very concise overview of climate change and healthcare.
    A couple of highlights from the article for me were highlighting the energy-intensive nature of healthcare systems and how by transitioning from energy intense, low yield procedures (Eg. unjustified imaging, medicationss, surgery) to biopsychosocial approaches (Eg. Explain Pain) we can better facilitate long-term environmental sustainability. Interestingly the authors exemplify better model healthcare systems such as those in Denmark, Holland and Cuba, as opposed to ‘high cost high impact systems in America.’
    Also, taking the liberty to quote a really nice paragraph towards the end of the article:
    “For some readers, especially those not yet convinced of the basic findings of climate science, these ideas and proposals may seem difficult to accept, or even to discuss or consider. Nevertheless, the evidence is robust and the basic science is sound, with tremendous consensus among those who have studied it (Cook et al., 2013; IPCC Working Group 2, 2014; Patz et al., 2014). For those that do not accept the scientific consensus, perhaps the health co-benefits expected to come from transitioning towards a carbon-neutral economy will be enough to gain acceptance, if not active support. For those whose minds are open to scientific findings, and are able to understand and accept the enormity of the climate-related challenges facing humanity, this essay may make more sense, and will hopefully stimulate thought and conversation to move us forward. As Costello reminds us, neither attitudes of climate change denial nor catastrophic fatalism should be used to guide societal-level decision making (Costello et al., 2011). Instead, we need to take a hard look at what the best science is telling us, and then work towards pragmatic approaches to maximize benefits and minimize harms”


    Barrett B, Charles JW, Temte JL. Climate change, human health, and epidemiological transition. Preventive Medicine. 2015; 70:69-75

  2. Hi Heyley, I’m celebrating 45 years since I qualified today. It that time it’s been an ongoing struggle to be accepted as a physiotherapist with something to offer to the medical professions let alone trying to bring them into the 21st century of the NOI paradigm…..!!!
    Don’t give up sweetheart your patients are profiting and, at the end of the day that’s all that matters x

  3. Hayey and Dianna,
    I am with you. Having just returned from 3 days in Philadelphia, high on EP3, I am facing reality back in Detroit. I envy your proximity to David and Lorimer-at least geographically, but I see we face the same philosophical/political challenges. Are you at least lucky enough enough to have like minded colleagues? It was such a treat to speak with like minded clinicians at EP3, it seems to have them near would surely lighten the emotional toll.

    1. The main reason that I continue to practice is that I surround myself with like-minded people. I am in an enviable situation where I am able to employ people who are as excited by the opportunities that EP provides us in improving people’s lives. We are also taking students into our practice who are often mind-blown with the approach. (That really is a big shame :-() Time our academic institutions taught pain as a core subject!! I am certainly finding that whilst the uptake has been slow, many patient’s are ready for a new approach.

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