Summary
Overview
Dr. Zand and Dr. Chris van Tulleken discuss chronic pain management with Dr. Cathy Stannard, a former consultant in chronic pain who now leads the Pain Transformation Program at NHS Gloucestershire. The conversation explores how understanding of pain has evolved, the crucial role of belief and validation in pain treatment, the limitations of medical interventions, and why exercise—particularly group exercise with a fitness instructor rather than a healthcare professional—is the only intervention NICE recommends for chronic pain management.
Cathy Stannard's Journey Into Pain Medicine
Cathy Stannard's path to specializing in pain medicine was serendipitous rather than planned. After breaking her hand and being unable to perform anesthetics, she was offered the choice between Christmas shopping or working in a pain clinic. She chose the clinic and discovered it was where she belonged, connecting her early interest in clinical psychology with her medical career. Years later, she found a letter from a physician in the 1980s suggesting she'd make a good chronic pain consultant—a specialty she hadn't even heard of at the time.
- Stannard became an anesthetist in Oxford but had her arm in plaster after rupturing a tendon, making it impossible to give anesthetics with one arm
- She won a prize for clinical psychology as a medical student, which anesthetic interviewers mocked, asking what the point was when patients are asleep
- A physician wrote her a letter in the 1980s suggesting she'd make a good chronic pain consultant, though she didn't know what that was at the time
" I wasn't drawn to pain medicine, but it's a story in itself. I was an anaesthetist in Oxford, and I had ruptured a tendon in my hand, so I'd had an operation, and my arm was in plaster. And you can't give an anaesthetic with one arm in plaster. "
" So what is the point of having a psychology prize when you're giving an anesthetic? It's because people are asleep. "
Evolution in Understanding Pain: From Molecules to Lived Experience
Early in her career, Stannard was fascinated by neuroscience and molecular targets for pain treatment, believing better knowledge of receptors would lead to cures. However, she observed that patients weren't getting better despite theoretically sound treatments. Over time, she learned from patients' stories that emotional baggage, trauma, and life circumstances—what she calls 'stuff'—play a crucial role in chronic pain. This realization shifted her focus from purely medical interventions to understanding the whole person.
- Stannard realized early as a senior registrar that people weren't getting better, initially thinking it was due to insufficient knowledge about receptors and neurochemistry
- She was fascinated by neuroscience developments and would find drugs acting on relevant receptors and give them to everybody, but patients still didn't improve
- She learned from patients that people had 'stuff'—emotional baggage and life burdens that impact pain
- Some of the best neuroscience has been in the field of pain, but nothing has led to a reliable medical treatment
" I was a senior registrar by that time that I wondered why people weren't getting better it was just an observation that we were doing these clinics and people weren't getting better "
" You realize that you look at yourself and i've got stuff everybody's got stuff you know the stuff is is i guess another word would be baggage "
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