Tame Pain

03/25/2025

A recent meta-analysis shows that most treatments for acute and chronic low back pain lack meaningful efficacy. Even those that outperformed placebo failed to reach a clinically important difference—meaning they likely don’t translate into real patient improvement.

Pain intensity reduction is often treated as the gold standard outcome, but it doesn’t have to be our only—or even primary—focus.

“Suffering may be related as much to the meaning of pain as to its intensity. Persistent helplessness and hopelessness may be the root causes of suffering for patients with chronic pain yet be reflected in a report of high pain intensity.”
— Ballantyne & Sullivan

“To understand the sufferer, one must understand the narrative, for it is through the story that the patient’s suffering is accessed. This means both hearing the illness story and listening for the suffering narrative therein.”
— Egnew, 2018

There’s value in expanding what success looks like in pain care.

Helping may have less to do with eliminating pain, and more to do with guiding patients through the pain experience—supporting them in returning to valued life activities. This process requires pain reconceptualization and a strong foundation of supported self-management strategies.

Short, powerful read by Ballantyne and Sullivan: https://lnkd.in/ee6b_v8G

Further reading on pain-related suffering from Peter Stilwell https://lnkd.in/eKG_jzVp

NYT article: https://lnkd.in/eFBtKA68

01/13/2025

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12/14/2024

The new year is upon us, and many people are contemplating change. Often, this involves doing something different in daily life; diet or physical activity. It’s much easier to think about change than implementing it. As humans, we get stuck in loops, our daily actions become automated and habitual. We find comfort in stability even if those choices are not the best for us in the long run. Breaking the loop is hard and our affordances are variable.

When attempting change, establishing a why is quite helpful, “I want to be more active so I can be healthier and around longer for my family”. That’s a great basis for change.

Once value, or a why, has been established, then it’s accepting change is a process. Just like our habits took years to establish, breaking out of them is going to take time. However, and this is important, small changes add up over time. There’s no need to commit to going to the gym 5 times per week when you’ve not been going at all for years. You may not even need to start with the gym. Making a realistic goal that fits with your life is key. Perhaps there’s space between when the kids are picked up at the bus stop in the morning and you needing to leave for work. Can we fit in a five minute walk? Maybe 2 sets of sit to stands in the kitchen?

These are my usual recommendations:
1) start small - it’s even ok if it initially feels somewhat easy.
2) make it fit your current abilities - if we’ve not been barbell back squatting, then starting with sit to stands to assess abilities makes a lot of sense
3) make it fit your life - new goals do not mean deprioritizing all other aspects of life. Yes, something may need to be reduced to create more time and maybe that’s a good thing (e.g., sitting for long periods for screen time)
4) find YOUR thing - just because it’s poplar to go to XFit doesn’t mean that’s what you just do too. Maybe you try it and don’t like it, that’s ok. Try something else. Maybe your thing is with others and maybe it isn’t, that’s ok too. On this health journey, what matters is enjoying the process so you stick with it. Then we can focus on nuance, like meeting physical activity recommendations.

Hope this helps!

08/25/2024

**A Comprehensive, Research-Based Guide to Shoulder Pain**

FREE at tamepain.com

Have you ever been told your “tight” upper traps are causing your shoulder pain? Or that your shoulder blade moves abnormally, leading to “impingement”? Maybe you’ve heard you should avoid certain movements, like upright rows, because they’re bad for shoulder health. If any of these narratives sound familiar, this guide is for you.

We’ll bring clarity to the causes of shoulder pain and examine the research behind these common explanations. Most importantly, we’ll provide a practical path forward to help you manage and alleviate shoulder pain effectively.

Struggling with shoulder pain? We can help. Click the link in our bio to set up a remote consult.

07/24/2024

Setting appropriate expectations is crucial when working through pain symptoms. Sometimes, we need to adjust activities due to symptoms. Instead of focusing on performance-based goals like numbers, sets, reps, time, or competitions, it’s better to stay active with tolerable symptoms to return to baseline. This shift helps embrace the process mindset and make appropriate progressions.

Comment below for a discussion.

07/22/2024

Rememberq - Although a prior experience with a movement may have involved pain, that’s not a reason to avoid a movement forever.

Movements aren’t inherently good or bad, harmful or not harmful.

Don’t let prior experience feed into fear avoidance.

07/04/2024

Happy 4th of July!

We are having a flash sale to celebrate.
Over the next two days, enjoy 20% OFF ALL ITEMS.
New or returning customers.

07/03/2024

Let’s talk about narratives.

Whether you are a clinician seeking to explain pain to a patient or an individual wanting to better understand their lived experiences, our words matter.

Many clinician narratives used to explain pain are rooted in an outdated model that views humans as machines, capable of wearing down, breaking, and needing replacement parts. This drastically oversimplifies our experiences, and runs the risk of harm. These narratives are often attached to the idea pain is a direct indicator of tissue damage to the body and if you experience any pain then avoid. Sadly, these narratives often lead to fear avoidance behaviors.

As individuals we want to understand and rationalize our experiences. We may latch on to the clinician narratives which maps to our daily behaviors. Additionally, our self talk may become negative, in which we view ourselves and our bodies differently, potentially negatively, perpetuating a broken mindset.

As clinicians we must balance our uncertainty with useful information and reassurance while minimizing a nocebo effect.

As individuals, positive self talk can go a long ways with self-management while also ensuring we don’t become too anchored to labels or a holy grail diagnostic search.

Hence , our narratives and beliefs map to our behaviors and world engagement … shaping our future experiences. These narratives have the ability to reach far into the future. Leading me to believe, that our words are likely one of the most important tools in our tool boxes, capable of empowering and reassuring or scaring and harming.

Thoughts? Tag someone who needs to read this. Like, comment, and share. 🙏

06/27/2024

***Movement and Pain***

Remember - Although a prior experience with a movement may have involved pain, that’s not a reason to avoid a movement forever.

Movements aren’t inherently good or bad, harmful or not harmful.

Don’t let prior experience feed into fear avoidance.

06/23/2024

Coaching Movement

One question we get a lot at , how do we coach movement?

When contemplating this topic, we tend to focus on 3 questions:

1. Is the person meeting the task demands?
For a squat, are they starting in an upright position, able to lower down to a preset arbitrary depth, and stand back up without losing balance.

2. Do they subjectively feel comfortable with their technique?
This is a process and over time one may find they prefer low bar to hi bar to leg press for example. Leading us to the last point.

3. Does the movement meet activity goals?
Why are we doing the activity? Is it to compete on the platform, hypertrophy, meeting resistance training recommendations for health.

Working through these questions helps find activity and movement recommendations for the individual.

Caveat: this isn’t an all encompassing post. Just some highlights. But if you notice, we have not said to avoid pain and injury in the above thought process.

Thoughts? Comment below for a discussion. Tag someone who needs to see this.

06/21/2024

Repost from
•
Here’s the deal with RICE, it’s outdated and for the most part became popular with little to no substantial evidential support.

At Tame Pain, we often get asked about RICE (Rest, Ice, Compression, and Elevation), here is an alternative set of approaches outlined in an editorial in the .

A few days (1- 3 days) after an acute tissue trauma (e.g. sprain or strain) you may want to follow, PEACE (Swipe left).

P = Protect = it’s ok to initially avoid or restrict activities and movements that may increase your pain in the first few days. To be clear, rest should be minimized but that doesn’t then mean go crazy.

E = Elevate = you may want to elevate an extremity injury higher than the heart to help with interstitial fluid flow out of the tissues. Admittedly we don’t care much about this one overall but doesn’t have much risk for harm.

A = Avoid Anti-Inflammatories = speaking of risk…we actually need an inflammatory response post injury to aid recovery…despite what some folks may say to sell a product or intervention. NSAIDs specifically are not without their own risks, especially with chronic usage.

C = Compress = taping or bandaging an extremity injury may help limit further edema and tissue hemorrhage. Also not one that is high on our priority list but if you want to, that’s cool too.

E = Educate = the authors said it best, swipe left.

After the initial few days, we can follow LOVE, think “I like to move it move it…” Final swipe left.

L = Load = continue to dose movement to tolerance and slowly build back up to baseline.

O = Optimism = Try to have a positive outlook and attitude towards the process.

V = Vascularisation = Cardiorespiratory activity is your friend, engage it. Helps with early mobilization and function.

E = Exercise = use exercise to help return to normal activities of daily living and extracurricular activities. Restore mobility (ability to move), strength, and function.

Thoughts? Tag someone who needs to see this. Spread the word and share.

06/20/2024

FREE access to The Guide to Knee Meniscus Tears

I’m actively working on The Guide to Knee Pain, which will come with an updated release of my knee rehab template. In anticipation of this new guide, I’ve decided to re-release The Guide to Knee Meniscus Tears, updated with free access. There’s a lot of misinformation on this topic, and I hope this guide is an informative resource for decision making in such scenarios. - Dr. Ray, Founder of Tame Pain

Excerpt:
The medical machine acts quickly. This is a good thing when situations are dire and life or limb are at stake. However, in less serious situations the expediency of the process may result in a failure to consider all the current evidence regarding diagnosis, treatment options, and their influence on prognosis. The urgency of the process may at first seem reassuring to the patient, instilling confidence that the clinician knows what they are doing. This process should be collaborative, but often it becomes authoritative. Patients are expected to make quick decisions as a layperson to the field. Thus, the process necessitates trust. Trust in the clinician, trust in the decision making, and trust that the information being delivered to them is the best we have (hopefully based on current research evidence).

https://www.tamepain.com/post/the-guide-to-knee-meniscus-tears

The medical machine acts quickly. This is a good thing when situations are dire and life or limb are at stake. However, in less serious situations the expediency of the process may result in a failure to consider all the current evidence regarding diagnosis, treatment options, and their influence on...

06/12/2024

Finding Relief and Strength: My Journey with Dr. Ray’s Pain Science Approach

“For the past two years, I have been experiencing non-specific back pain. I had tried out several different options such as physical therapy, taking time off work, and consulting with a medical doctor. Not only was my pain persistent, but the advice I was getting, “Don’t lift heavy things in the gym”, “You need to stretch more”, and “You are wearing out your back”, led me to become more frustrated. During my search for a remedy for this problem, I came across pain science and Dr. Ray’s work.

Dr. Ray’s work made a lot of sense to me, but I was still unsure of the process as it was very different advice from what other medical professionals had told me in the past. My back pain was negatively affecting every area of my life so I decided to give Dr. Ray’s approach a try. I purchased a consultation with Dr. Ray and explained my situation and past experience dealing with my back pain. He told me he was happy to help and we had a Zoom meeting where we discussed the process and first steps towards getting back to doing the things I enjoyed. Communicating with Dr. Ray was very refreshing because he really wanted to understand my experience and wasn’t just telling me all the things that I did wrong and how they were influencing my back pain. After the Zoom meeting, I felt a lot of relief and I felt confident that he could help me get back to all the things I enjoy doing.”

Read more at tamepain.com.

https://www.tamepain.com/post/finding-relief-and-strength-my-journey-with-dr-ray-s-pain-science-approach

For the past two years, I have been experiencing non-specific back pain. I had tried out several different options such as physical therapy, taking time off work, and consulting with a medical doctor. Not only was my pain persistent, but the advice I was getting, "Don't lift heavy things in the gym"...

05/29/2024

Words can harm. We may mean well and just trying to help, but our narratives about pain experiences, the meaning of such experiences, and how to respond can have profound impact on someone’s beliefs and behaviors.

This is a quote from someone I’ve been working with (shared with permission).

Unfortunately, it’s a common theme I hear when working with individuals experiencing pain.

“I got most of my fears surrounding my body within the last year, and it was from doctors telling me not to work out, not to ride my bike, not to squat, not to lift weights.”

We can and must do better.


Have you heard harmful narratives from healthcare professionals regarding pain and activity? If so, comment below. 👇

05/28/2024

Does Krill oil effective treat knee pain related to OA?

Based on a recent study in JAMA, it doesn’t appear so.

You may be wondering - what is Krill oil exactly?
It’s a marine version of omega-3 fatty acids derived from Krill, an aquatic arthropod.

Why do we think this may help osteoarthritis related knee pain?
Prior studies in rheumatoid arthritis showed improvements for outcomes such as pain reporting.

Krill oil is thought to have a distinct advantage due to containing an antioxidant known as astaxanthin - which may help reduce free radicals and associated oxidative stress as well as reducing inflammation.

Wait, is inflammation linked with OA?
It depends. These researchers specifically recruited those with joint effusions (“water on the knee”) as well as imaging documented synovitis - inflammation/thickening of the synovium, that membrane which lines our synovial joints. These radiological findings have previously been linked to greater pain reporting.

3 prior trials showed some effectiveness of krill oil in this context but didn’t assess effusion-synovitis.

The researchers did a phenomenal job on designing the study to appropriately assess their primary outcome, which was pain intensity measured through the visual analog scale. VAS is a scale of 0 - 100 where 0 = no pain and 100 = most intense pain possible for the individual. They set the minimally important clinical improvement at 15 points on the scale. 262 participants were randomized to either placebo or krill oil. The krill oil group received 2 grams/day in a gel cap form and placebo received the same appearing gel cap without the same “active” ingredients in the krill oil (e.g., DHA/EPA). The authors gathered A TON of secondary outcomes but we won’t go into that at this time. After 24 weeks, both groups had reduction in knee pain without a meaningful difference between groups.

Takeaway: when it comes to using krill oil for OA related knee pain, save your money and don’t buy krill oil … yet.

05/13/2024

New Blog Post https://wix.to/I5JnmXS
The Clinician's Narrative: Why Words matter

The Clinician's Narrative - Why Words Matter

04/30/2024

In honor of combating misinformation, for a limited time only, here is free access to The Guide to Low Back Pain Tame Pain

Most humans will experience low back pain (LBP) at some point in their life. Despite the prevalence of LBP, there remains significant misinformation surrounding why it occurs. In this guide we will bring clarity to the discussion based on current research evidence, while outlining a path forward for...

04/29/2024

Embrace your unique movement style!

Don’t fall prey to movement perfectionism. Remember, movement is as unique as handwriting - each person has their own style and that’s totally fine!