Pain Coach

Lachlan Townend sits down with Dr Lisa Shelley, a general physician and addiction medicine specialist at Currumbin Clinic, to talk about one of the most stigmatised overlaps in healthcare: chronic pain and substance use.

Lisa explains what addiction actually is, and why a high dose of a prescribed opioid doesn't, on its own, mean someone has an opioid use disorder. She walks through how "liking" becomes "unwanted wanting" in the brain, why opioids lose their benefit for chronic pain ("there is no top to that mountain"), the danger of adding pregabalin to an opioid, and how buprenorphine keeps people alive.

The conversation also covers the signs of opioid misuse, whether opioid-induced hyperalgesia is as common as we think, and the first step for anyone worried about their own use. Lisa shares the recovery skill she teaches every patient, learning to "sit in the mud", and why fun belongs alongside sleep, food and movement.

Whether you're a clinician, living with chronic pain, or a worried family member, this is a compassionate, practical and hopeful conversation.

Disclaimer: This podcast is not personalised medical advice. Please consult a health professional before acting on anything discussed.

RESOURCES:

• Pain Coach: turns complex chronic pain into simple habit targets. Free for early adopter clinics: paincoach.co
• Dr Lisa Shelley: Currumbin Clinic profile
• Tame the Beast: a short animation on understanding persistent pain
• THIS WAY UP Chronic Pain Program: a free online course
• National Alcohol and Other Drug Hotline: 1800 250 015, free and 24/7
• Peer support: NA, AA, SMART Recovery, Recovery Dharma

KEY TOPICS:

00:00 - Teaser
02:01 - Leading with validation: how Lisa works with patients
09:18 - What is addiction? Dependence vs opioid use disorder
12:57 - The neurobiology of addiction: from liking to "unwanted wanting"
18:02 - Substance use in the context of chronic pain
20:05 - Medicinal cannabis for chronic pain
21:26 - The most common substance problems in chronic pain
22:42 - Overdose deaths and how buprenorphine keeps people safe
28:18 - Treating an opioid problem with opioids?
31:52 - Learning to "sit in the mud"
35:10 - Why there's "no top to that mountain" with opioids
36:28 - The danger of combining pregabalin and opioids
37:11 - Signs of opioid misuse to look out for
42:27 - Is there a safe opioid dose?
46:28 - Opioid-induced hyperalgesia: how common is it?
49:09 - Opioid documentaries and the OxyContin story
54:24 - Worried about your own use? The first step
55:42 - Where to get help in Australia
58:39 - The non-negotiables: sleep, food, movement, connection and fun
1:00:45 - Pain science education and Lisa's own back pain
1:03:51 - Lisa's advice for someone in pain right now

Lachlan Townend chats with Dr Mitchell Gibbs - Senior Lecturer and Program Lead in Exercise Physiology at UNSW Sydney and a researcher with NeuRA - to unpack one of the most valuable, yet contested corners of chronic pain care: exercise.

Mitch's own research journey started exactly where most clinicians start - hunting for the specific exercise, the right modality, the movement pattern that would fix a person's pain. What he found, across a PhD built around powerlifting and years of research since, upended that: the evidence increasingly suggests all exercise works about the same, that getting stronger doesn't appear to be what actually helps, and that whether exercise is painful or pain-free barely moves the needle either. What matters, again and again, turns out to be self-efficacy, fear, belief, and above all whether the movement is meaningful to the person doing it.

The conversation ranges from the "philosophy is a luxury" dilemma of trying to hold scientific nuance and a patient's need for a clear answer in the same hand, to why most exercise trials for back pain and knee osteoarthritis don't even come close to the physical activity levels needed for someone's broader health, to the emerging idea of "exercise snacks" as a low-barrier way back into movement. Mitch also shares the very personal story of being a supremely confident 20-year-old personal trainer who thought he'd cracked back pain and the moment his supervisor told him, "now you get it," when, despite his bravado, none of his clients were getting better.

Whether you're a clinician prescribing exercise for persistent pain, a researcher, or someone living with chronic pain trying to work out what's actually worth doing, this is a grounded, refreshingly honest look at what the evidence does and doesn't tell us and what to do with that uncertainty in the room with a real person.  

RESOURCES:
- Pain Coach: clinical software helping clinicians turn complex chronic pain into simple habit targets. Sign up for free: here
- Dr Mitchell Gibbs - Research profile, UNSW Sydney
- Full publication list: Google Scholar

KEY TOPICS:
0:00 — Intro + Disclaimer  
01:43 — The evolving landscape of exercise for chronic pain
03:27 — Mitch's own paradigm shift, from Masters to PhD 05:15 — Is "exercise cures back pain" content garbage?
07:13 — Does getting stronger actually reduce pain?
11:00 — Painful vs. pain-free exercise: the updated review
15:19 — The role of pain education
20:37 — Philosophy vs. pragmatism: research nuance vs. what patients actually need
24:46 — How to actually prescribe exercise — the CAPACITY trial and patient-led goal setting 30:44 — Chronic pain as multimorbidity, not an isolated condition
31:38 — Adherence, dose, and meaning: what really predicts success
38:34 — Case study: getting a "non-mover" moving again
41:47 — Exercise snacks and the "controlled chaos" model
44:51 — Origin story: an overconfident 20-year-old PT, and "now you get it"
50:46 — The multimorbidity research: less than 1% of trials meet WHO guidelines
57:32 — Advice for someone with chronic low back pain right now

Disclaimer: This podcast is not personalised medical advice. Please consult a health professional before acting on anything discussed.

Lachlan Townend sits down with Derek Griffin (PhD), a Clinical Specialist Physiotherapist (Pain) and pain researcher based in Tralee, Ireland, who has spent his career untangling the science of chronic pain without losing sight of the person in front of him.

Derek shares why he sees pain as a fundamentally protective (sometimes overprotective) system, and why he refuses to get lost in debates about nociception, central sensitisation and nociplastic pain when a patient in front of him needs a real next step.

The conversation covers the fatigue of being told "pain is complex" without ever getting something actionable, the shift from treating a joint to treating a whole person, why the simplest lifestyle levers such as sleep, exercise, social connection, psychological wellbeing and nutrition are most pivotal and Derek's honest take on the debate around hands-on therapy.

Whether you're a clinician working in a multidisciplinary team, someone living with persistent pain trying to make sense of your own story, or somewhere in between, this episode is a grounded, evidence-informed and genuinely human look at what it takes to help someone recover their quality of life.

RESOURCES:

- Pain Coach: Clinical software helping clinicians turn complex chronic pain into simple habit targets. Sign-up here: https://paincoach.co
- Derek Griffin's socials:  X | Instagram | LinkedIn
- Listen to Peter O'sullivan episode mentioned here

KEY TOPICS:

00:00 — Teaser
00:54 — Medical disclaimer
01:41 — Interview starts: Derek's marathon running and PB (2:27:04, Valencia)
04:22 — Why Derek got into chronic pain: his PhD path
06:37 — What his PhD research found
08:42 — Derek's clinical role at Bon Secours Hospital
10:58 — Why multidisciplinary care matters
11:37 — How Derek explains pain to patients
12:01 — The "is pain a protector" debate
14:02 — The neuroimmune system, explained simply
16:34 — Where modern pain explanations go wrong
18:41 — Why pain education has to drive behaviour change, not just belief
21:19 — Navigating different beliefs inside a multidisciplinary team
23:52 — Zooming into the nervous system: nociceptive vs. neuropathic vs. nociplastic pain
30:39 — The "pain is complex" fatigue
34:57 — Why simple lifestyle advice can feel invalidating - the habit-change problem
37:57 — The biggest controversy in pain science: is nociception necessary for pain?
41:15 — Shifting from "joint health" to "person health" (knee osteoarthritis)
46:14 — The big five modifiable factors: sleep, exercise, social connection, psychological wellbeing, nutrition
47:31 — How sleep affects the neuroimmune system — and your pain
54:05 — Pain Coach ad
54:33 — Is hands-on treatment necessary? The telehealth debate
1:00:29 — Derek's advice for anyone currently in pain

Disclaimer: This podcast is not personalised medical advice. Please consult a health professional before acting on anything discussed.

Got a sore back and rolling your eyes at the idea of "seeing a psychologist for it"? You're not alone and this episode is for you.

Lachlan puts that exact skepticism to pain psychologist Sophie and what follows is a masterclass in the real, physiological role psychology plays in persistent pain. They unpack the "window of tolerance," why the nervous system can become overprotective, how adverse life experiences shape our pain response and why phantom limb pain proves pain is never just about tissue damage.

From practical tools - progressive muscle relaxation, the stress bucket analogy, graded exposure, CBT, ACT and pain reprocessing therapy - to the bigger picture of why multidisciplinary care changes outcomes, this conversation bridges the physical and psychological divide that so many pain patients get stuck in.

Disclaimer: This podcast is not personalised medical advice. Please consult a health professional before acting on anything discussed.

"When Tasha speaks about pain, everyone should listen" - Merv Travers (previous guest and pain researcher)

In this episode, Professor of Clinical Pain Neuroscience, Tasha Stanton translates the current science of persistent pain into practical reasoning.

Tasha explains that pain is a protective system that can become over-sensitive - in her words, "a system that's working too well." She's candid about what she's moved away from over her career — why giving the brain sole focus, and the notion that "the brain decides," are both inaccurate - and what it takes to communicate pain science without a patient hearing it's all in your head.

From there it's straight into application: assessing body perception and two-point discrimination, sensorimotor and tactile discrimination retraining, what the RESOLVE trial suggests about mechanism, the role of systemic inflammation and why loading helps, and using active inference and predictive processing to drive change - including her group's VR cycling work, which improves how patients feel while they work harder.

Could the key to easing chronic joint pain lie in how you sleep?

In this episode, Lachlan Townend talks with Associate Professor Michelle Hall from the University of Sydney's Musculoskeletal Research Hub. They unpack what osteoarthritis really is, why your X-ray often doesn't match how you feel and why myths like "bone on bone" and "exercise wears the joint out" don't hold up.

Then they turn to sleep — why poor sleep doesn't just follow pain but can actively drive it, how cognitive behavioural therapy for insomnia (CBT-I) helps most people within weeks, often without medication and what Michelle's clinical trials could mean for the future of pain care.

If you live with pain, or treat people who do, it's a practical and hopeful listen.

Resources

• Is sleep contributing to you or your patients' pain? Try Pain Coach for free and find out: Click here
• Lachlan Townend on LinkedIn: https://www.linkedin.com/in/lachlan-townend/
• Michelle Hall on LinkedIn: https://www.linkedin.com/in/michelle-hall-548627111/
• Michelle's research profile: https://profiles.sydney.edu.au/michelle.hall/about
• Musculoskeletal Research Hub, University of Sydney (Charles Perkins Centre): https://www.sydney.edu.au/charles-perkins-centre/our-research/research-groups/musculoskeletal-research-hub.html
• Musculoskeletal Research Hub on LinkedIn: https://www.linkedin.com/company/111559366/
• Online sleep resources based in cognitive behavioural therapy for insomnia (Sleepio): https://sleepio.bighealth.com/
• SLEEP-FIT Trial (sign up): https://redcap.sydney.edu.au/surveys/?s=AKTTJLD44NNMYMHK
• Referenced paper (open access): Klyne DM, Hall M. Is sleep the new treatment for pain? Two issues need resolving before deciding. Sleep. 2024;47(6):zsae089. https://doi.org/10.1093/sleep/zsae089

Key Topics:
00:00 Intro
01:19 Michelle's path into research
04:00 Why her dad's pain started it all
08:23 From biomechanics to the whole person
13:04 What osteoarthritis really is (and why scans mislead)
19:52 Myths, exercise & weight loss
27:57 Why sleep matters in pain
31:14 Is sleep the new treatment for pain?
34:16 CBT for insomnia, explained
43:52 Inside the trials
52:07 Beyond knees: other pain
55:24 Where to start
57:23 One habit from lasting relief
58:20 Find Michelle

Disclaimer

This podcast is for educational purposes only. The views expressed do not constitute medical advice and are general in nature. Please obtain specific advice from a qualified health professional before acting on any information in this episode.

For decades, pain care has run on a simple question: what's wrong with you? Risk factors, deficits, pathology, problems. It's well-intentioned but could the deficits focus being making things worse?

In this episode of Pain Coach, Lachlan sits down with Dr Niamh Moloney and PhD candidate Barry Moore from Curtin University to unpack a quietly radical reframe in persistent pain research: stop leading with what's wrong, and start asking what's right.

Niamh shares the the beachside journaling session that flipped her thinking. Barry walks through his newly published scoping review in the European Journal of Pain, surfacing 79 studies on protective factors like self-efficacy, optimism, resilience and social connection, that help people live well with pain.

Crucially, this isn't toxic positivity. It's not about ignoring pathology or dismissing what hurts. It's about refusing to reduce a person to a list of their risk factors and building care around the resources they already carry.

If you've ever walked out of an appointment feeling smaller than when you walked in (or  unintentionally sent a patient home that way) this conversation will change how you think about pain care.

One problem in, a couple of solutions out. That's the goal.

RESOURCES:

• Free trial of Pain Coach: https://paincoach.co?utm_src=podB&N
• Dr Niamh Moloney on X: https://x.com/drniamhmoloney
• Barry E. Moore LinkedIn: https://www.linkedin.com/in/barry-moore-006a24145/
• 📄 Moore, B. E., Schleidgen, L., Hang, C. P., et al. (2026). "Protection from Chronic Musculoskeletal Pain: A Scoping Review." European Journal of Pain, 30(4): e70273. → https://doi.org/10.1002/ejp.70273
• 📄 Rabey, M. & Moloney, N. (2022). "I Don't Know Why I've Got this Pain!" Allostasis as a Possible Explanatory Model. Physical Therapy, 102(5), pzac017. → https://doi.org/10.1093/ptj/pzac017

KEY TOPICS

00:00 — Intro

00:43 — Disclaimer & welcome

01:22 — Meet Dr Niamh Moloney & Barry — paths crossing at Curtin

03:05 — What is chronic / persistent pain?

05:18 — Why pain persists: the multifactorial picture

09:35 — Central sensitisation in lay terms

12:47 — Why "central sensitisation" grinds Niamh's gears

15:36 — How to know if your nervous system is involved

18:43 — Niamh's lived experience of persistent pain

20:34 — The "why" behind the wider project

24:46 — The allostatic load paper: "I don't know why I've got this pain"

26:14 — Confronting her own risk factors

27:55 — The beach notebook: writing down what kept her well

29:44 — CliftonStrengths and the leadership lightbulb

31:39 — From deficits to strengths: a research pivot

33:09 — Antonovsky, Holocaust survivors & the salutogenic model

36:16 — Barry's scoping review (European Journal of Pain) — 79 studies

38:25 — Strengths aren't just the opposite of risk factors

40:04 — What surprised the researchers

43:30 — Lived experience: how people actually use their strengths

46:13 — Strengths ≠ toxic positivity: validating patients first

48:56 — Why disability (not pain) was the chosen outcome

51:22 — Pain intensity work is coming next

52:43 — The decade-long wider project & future studies

56:58 — Building hope, not despair

58:18 — Advice for someone at their low point

1:04:04 — Where to follow Niamh and Barry

Dr Millie Mardon is a pelvic pain researcher at Western Sydney University with her own lived experience of the condition. Diagnosed with endometriosis at 14 after years of debilitating period pain, Millie navigated surgeries and a complex healthcare system — and is now happy to say she is pain-free. That experience became the foundation of her entire research career.

RESOURCES: 

• Try Pain Coach for free
• Millie's Research "I Wish I Knew Then What I Know Now" 
• Millie's Instagram 
• Millie's researcher profile

KEY TOPICS:

0:00 — Introduction & trailer
1:25 — Why Millie devoted her life to pelvic pain research
3:12 — Millie's personal story: endometriosis from her first period
3:36 — The 7–9 year diagnosis delay in Australia — and why it matters
7:23 — The role of parental advocacy in getting answers
9:26 — Is a diagnosis the be-all and end-all?
12:55 — Pain-free for over 10 years
14:06 — What Millie thinks made the difference in her recovery
16:17 — "I Wish I Knew Then What I Know Now" — her landmark research study
18:05 — The 4 pain science education concepts that actually help people with pelvic pain
22:34 — Where lifestyle fits into pain: sleep, stress, diet & exercise
25:40 — How a medical scientist ended up in pain research
27:24 — The influence of Lorimer Moseley, David Butler & Explain Pain
29:45 — What actually is endometriosis?
33:20 — Prevalence: 1 in 7 women, 1 in 5 with persistent pelvic pain
34:48 — Why is endometriosis still so underfunded?
40:09 — Surgery for endometriosis: what does the research actually say?
40:43 — The Melbourne surgery scandal (ABC Four Corners: Scarred)
42:05 — The real numbers: 50% improve, 25% stay the same, 25% get worse
43:26 — Ablation vs excision: which works better and why
48:38 — The danger of swinging too far — biomedical vs biopsychosocial
52:46 — Millie's current research projects
53:28 — The pelvic pain social media campaign for young people
54:39 — The EndoEd trial: pain science education before laparoscopy
56:14 — The big unanswered question: why do some people get better and others don't?
57:14 — Gut health and endometriosis: 97% of people have GI symptoms
59:50 — Millie's parting advice for anyone navigating pelvic pain

If you've been told your pain is "all in your head" or that it's purely a problem with structures in your body - this episode will challenge both of those ideas.

Dr Merv Travers is a physiotherapist, PhD researcher and strength & conditioning coach based in Perth, Western Australia. He's a Senior Research Scholar at the University of Notre Dame Australia, working in the areas of low back pain, tendon pain, and exercise rehabilitation.

In this conversation, Merv explains why pain belongs to the whole person - not just the brain and not just the body. He breaks down active inference and predictive processing in plain language, shares a story of a professional athlete he treated for Achilles pain and makes a compelling case for why the RESOLVE trial may be the most important musculoskeletal pain trial we've ever had.

We also explore the common threads between some of the best research that has been done on persistent pain - Cognitive Functional Therapy, Pain Reprocessing Therapy and Graded Sensorimotor Retraining - and why Merv believes the active inference framework ties them all together.

Whether you're a clinician looking for a better way to treat persistent pain or someone living with pain who's been told nothing else can be done - this episode offers real hope backed by real science.

RESOURCES:

• Try Pain Coach for free
• RESOLVE      Trial (Bagg et al., JAMA 2022)
• The Fit for Purpose Model (Wand      et al., Physical Therapy 2022) 
• Recognise App (for      laterality training)
• Dr Merv Travers / Optimise Rehab

KEY TOPICS

00:00 — Teaser & Introduction
01:05 — Merv's Mission: Helping Clinicians Help Patients
02:44 — How Do You Understand Pain?
04:13 — Predictive Processing Explained Simply
08:00 — The Teacher Who Said "Your Back Never Heals"
09:50 — Beyond Predictive Processing: Active Inference
12:02 — Pain Equals Body Damage x Nervous System Threat?
14:19 — The Wine Experiment: How Expectations Shape Experience
18:02 — Why Every Person's Pain Is Unique
21:48 — Treating Athletes: The Culture of Structural Thinking
23:28 — The Achilles Story: "I Don't Know What I'm Going to Do"
24:56 — Sensory Acuity Testing: "Foot Fetish Tinder"
27:07 — The RESOLVE Trial: The Most Important Pain Trial We've Had
30:21 — Why The Trial's Rigour Matters
31:40 — CFT, Pain Reprocessing Therapy & What's Coming Next
33:58 — The Common Threads Across All Three Treatments
37:07 — Get To Know Your Patient (Pain Coach Ad)
37:33 — Movement Experimentation & Modifying Symptoms
44:05 — Manual Therapy Isn't Excluded From This Framework
48:56 — The Fit For Purpose Model: Three Pillars
51:07 — Self-Evidencing Through Movement
54:19 — The Placebo Effect Is Not A Dirty Word
58:55 — A Universal Truth For Someone In Pain
01:01:21 — Where To Find Merv Travers

Dr. Rachel Zoffness (PhD) is a pain psychologist and author who has devoted her career to understanding why we suffer with pain and what we can actually do about it.

We discuss:

• The childhood experience with chronic pain that sparked her obsession with understanding suffering. 
• The "biopsychosocial" truth about pain that medicine has known for 65 years but never tells patients. 
• Why the healthcare system only treats one-third of the pain problem. 
• The "pain dial" in your nervous system and the three factors that turn it up or down. 
• How she learned to warm her hands to 90 degrees using only her thoughts. 
• The difference between a "high pain recipe" and a "low pain recipe" – and how to craft yours. 
• If there is an off switch for pain and whether you would want one. 

And much more...

Rachel's new book Tell Me Where It Hurts is out March 24th and is available for pre-order on Amazon.

RESOURCES

• Pain Coach: Find Lifestyle Targets for Treating Pain 
• Tell Me Where It Hurts
• Rachel's Website
• Book an appointment to see Lachlan
  

KEY TOPICS

00:00 The lie medicine has sold you about pain

01:24 Why Rachel devoted her life to studying pain

03:02 Chronic pain as a child & what she wishes she'd known

05:28 What is pain? The biopsychosocial model explained

08:05 The three domains: Bio, Psych & Social

09:05 The missing two-thirds of pain treatment

11:32 Why pills and procedures aren't working

12:13 Central sensitization: How pain becomes chronic

15:01 The piano analogy: Your brain practices pain

17:50 Is there hope? Can the pain pathway shrink?

25:52 The Pain Dial: How to turn your volume up and down

26:15 Factor 1: Stress and anxiety

26:40 Factor 2: Mood and emotions

27:25 Factor 3: Attention and focus

28:16 The good news: The opposite is also true

30:18 Is there an on/off switch for pain?

32:04 Why opioids work (and it's not just physical)

33:39 Can chronic pain ever fully disappear?

35:32 The Pain Recipe: High pain vs low pain ingredients

38:35 Crafting your low pain recipe

41:51 Habit change & lasting pain relief

45:08 Biofeedback: How Rachel learned to warm her hands to 90 degrees

51:42 Your thoughts literally change your biology

53:16 Biofeedback is as effective as migraine drugs

54:16 This isn't "manifesting" – it's science

55:55 How to reduce fear during a pain flare

58:24 What surprised Rachel while writing the book

01:00:26 About "Tell Me Where It Hurts"

01:02:10 Rachel's parting advice: Write your pain recipe