This is Airing Pain, a programme brought to you by Pain Concern, the UK charity providing information and support for those of us living with pain and for healthcare professionals. I'm Paul Evans and this edition has been funded by a grant from the Doily Cart Charitable Trust. Some of the greatest biodiversity in the country is actually in the city. About a third of London is covered in green space. A lot of those green spaces are filled with trees, they're filled with hedgerows, they're filled with ponds, they're filled with lakes. Some of our national parks and some of our best natural spaces that we have, you could say have a lot.
lower biodiversity value than some of the spaces within a city. You know, it's really important to have both and a wide range of different species, but there is so much value in urban ecology. In this edition of Earing Pain, I'm going to explore how that value can be extended to those of us living with chronic pain. Green Gym is a nationwide programme that supports positive changes in the health of participants and the green spaces they create and maintain. It helps to transform people's health and well-being through weekly participation in outdoor activities such as conservation, park management and growing food. Each Green Gym project mobilises community members to work together and volunteers become physically active while improving their local environment.
Craig Lister is the Managing Director of Green Gym. The Green Gym is effectively the outdoor world. It's specifically not equipment you see in parks. We don't do that. I'm an exercise physiologist by trade, and I have a particular interest in evolution, how we evolved. We evolved in the outdoor world for the vast majority of our lifespan, so 200,000 or 300,000 years, depending on which research you look at. And we became perfectly attuned to living in the outdoors. And so muscle is what we call an endocrine organ. It releases different hormones in response to physical activity, temperature changes.
We typically function during the day, so the amount of light in our eyes changes brain chemistry and other chemistry. And actually, we became so good at living in the outdoor world, amongst all of the species that there are, that we became the world's dominant species. So clearly, we were really, really good at that. And Green Gym really seeks to take us back into that environment, which is the outdoor world, working in groups because we're a pack animal and we like to work in groups. We do physical activity, but it has a purpose. So we'll plant trees, create paths, open areas for other people to enjoy. And those things in combination seem to have a very positive impact on health and well-being, particularly mental health, depression and anxiety, which in turn tends to have a positive impact on pain. My name is Maria.
I'm the Senior Project Officer for the Camden Green Gym, which is a volunteering programme run by the conservation volunteers. We organise twice-weekly sessions, three hours at a time, for anyone who wants to join. It's open to all ages, all walks of life, and volunteers work in the green spaces in Camden, in the local parks and community gardens, urban woodlands, and we use the time to improve the biodiversity, to improve access for the public. to make sure that wildlife thrives, that green places are looked after, that we pick litter. We try and help Camden Council to keep them in good condition. And in the process, the volunteers get active, they improve their physical and mental well-being, and they have a nice sociable time. Today, it's a special day. We don't normally work on the tools. It's a kind of twice-yearly event. But we've combined that with our summer barbecue, so it's a social event today as well. Normally, we tend to cut back vegetation, build insect hotels or work in the pond.
build deadwood hedging, that kind of thing. Lots of different activities. Where exactly are we? We're in Waterloo Park, which was donated in the 19th century, to become a garden for the gardeners. So it's a fantastic resource for North London. It's a really beautiful park. And we work in a couple of nature reserve areas where we work. And we also support, at times, support the Friends of Waterloo Park. It must be a barbecue day because the rain is forecast. Well, we come prepared. We have two gazebos. So hopefully we won't have to use them. But it's fine.
I mean, our volunteers are very hardy because they come out in all weather. We come out in the winter, come rain, shine. I'm still surprised how dedicated our volunteers are because even when it's bucketing down, a group of them turn up. But the whole idea is to be outdoors, to get exercise, to be connected to nature, be connected to other people, keep active, which of course is incredibly good for chronic pain relief. It's very good to keep...
fit and just being out in nature is incredibly good for your mental well-being and the great thing about the outdoors and the garden is that it's never finished exactly it's not as if the course can end after six weeks yes there are always surprises there was lovely things to see It's nice for the volunteers to see the kind of work they've achieved, and also to see the wildlife, to see the birds, the insects, and see the flowers, and experience the seasons, which is really important, I think, especially for people living in cities, often if they don't have gardens themselves. It just really enhances people's well-being. My research degree was on community-based interventions for chronic low back pain, and there are a number of measures for that. But what I found as a physiologist, which was surprising to me in my early years as a physiologist, was a questionnaire called the Fear Avoidance Belief Questionnaire. It was a better predictor of pain.
And that is a psychological questionnaire, and that means I'm not going to do something because I'm fearful it will hurt me. I don't do it. I become less active. I'm less able to support my spine. I'm more likely to feel pain at a jar, and it becomes a self-fulfilling prophecy. Obviously, there's more to it than that, but in simple terms, that's it. Whereas my research, and in fact, Green Gym is very similar, we get people to do things that are intrinsically interesting and in a group. And so for an amount of time, they forget about the pain, if you like. And sometimes that's referred to as the distraction hypothesis. So I'm doing something else that is attracting most of my conscious attention.
And then you can reflect back on what you've done, and other people say, what a good job you've done. And in fact, when we were working in London this Saturday, other members of the public were coming to say, what are you doing? Thanks for doing that. And so people think, well, actually, do you know what? I have done something. I do feel better about myself because of that. But actually, at the same time, because we operate in a free environment, digging, cutting, whatever it may be, we're building muscle strength and muscle control that protects people from pain in the future. My name's Rosie Broadley. And you have chronic pain. I have chronic pain on a daily basis. It's pancreatitis and liver failure, which liver failure really messed my body up, and I went to less than six stone. How long have you been involved in Ginger?
Not this green gem, but I've been doing it for about six months now. So it's helping me tame my muscles up. It's helping me stop focusing on pain the whole time, every single day. And people have said that my face has changed since I started. My literal face has changed.
I started smiling a little bit more. If you're in chronic pain, you know that it's constant. It's there with you. The only way that you can get your head away with it is to do something else. Take your mind off of it. And gardening really, really does help. There's so many problems whilst I'm cutting the hazel bushes. I feel like I've had a full-blown conversation in my head. And that is helping now. Otherwise, I'd just be sitting at home watching TV with my dog, and I would be probably doubled over.
This should be given to the doctors. It should be prescribed by the doctors. But six months ago, if a doctor had said to you, I think you should go gardening, what would you say? I just thought I wouldn't be able to do it. No, I don't know these people. What am I supposed to do? I'd be all embarrassed. I'd be all like... But now, it's like water off a duck's back.
It's helped me so much alleviate my pain, it does. Even just to walk to going to the green gym, knowing that I'm getting up and doing something, alleviates it in a certain way. Assistivating pain will know that psychological wellbeing is good and the psychological therapies, cognitive behavioural therapy, they're good. It can often be difficult explaining to somebody that you need your head mended or your brain mended, if you like. But recommending physical work when somebody's in pain, I mean, that's another barrier, isn't it? It can be, yeah, and again, that's perception.
You'll know that, again, let's focus on back pain, the medical evidence has changed. The medical evidence used to be go back and rest, lay down, don't do anything, which we now know is the worst thing that you can do. So with everything, medical evidence advances. But muscle is an endocrine system. It produces lots of different chemicals. And a lot of those chemicals are anti-inflammatory or pain-reducing. And for a lot of pain, the actual pain is caused by inflammation of muscle or tissue pressing on the nerves, and that causes the pain. So if you are physically active and you produce these natural products that reduce inflammation, that can be one mechanism towards reducing pain.
And then the other one, or another one, is increasing stability in all your muscles. So people talk about core stabilisation. Sometimes I think that's a bit fatty. It doesn't really matter. You do need a strong core. So a simple example is stepping down a step that you didn't know was there. I'm sure we've all done that once or twice, and you get that jarring sensation. If your core is strong, and importantly, if you are able to recruit your muscles very quickly, without knowing that, just doing it very quickly because you're regularly physically active, you're much more likely to stabilise yourself very quickly and reduce your pain there.
It may seem counterintuitive. I don't think it is that physical activity is good for pain reduction. I just think we've been told it is, and now we believe that's true. But I don't think it ever was true. The only caveat I would put to that is it has to be appropriate physical activity, which is the right level and interesting. That's Craig Lister, Managing Director of Green Gym. And this seems like a good time to remind you that whilst we in Pain Concern believe the information and opinions on airing pain are accurate and sound based on the best judgments available...
You should always consult your health professional on any matter relating to your health and wellbeing. He or she is the only person who knows you, your circumstances and therefore the appropriate action to take on your behalf. My name's Maddy and I used to be a volunteer officer for the Green Gym in Camden. I was at VO for two years and I had a period of illness and it helped me get back on my feet and gave me confidence and I then left a year ago and went on to work somewhere else, paid work. So, I mean, it's been incredibly helpful for me. In what way? I have depression and anxiety and so it really wrecks your confidence.
You get taught here to lead groups to do the warm-up, the warm-down, the tools talk. And it helped me gain confidence, basically, because I was looking after 15 volunteers. And being outside is just incredible. And it's definitely true. You feel more connected if you're working with nature. And I do feel very passionately about environmental concerns.
Just explain to me how it helps depression and anxiety. First of all, you're working with other people and they may also be people who have depression and anxiety. So it's not anything like, oh God, you know, you're mentally ill. There's none of that. It's just like everyone mucks in together. And then there's also having the connection with nature and using your hands, digging and planting wild meadows and looking after the habitats that we encounter. It made me feel very peaceful and my anxiety levels went right down.
it's a really lovely thing to do also if you just don't really know if you want to change your career and you think i need to have some time and and sort of do this and i've seen a lot of people come through the green gym who've decided they want to change their careers and they weren't sure what to do and then they do go into like environmental charities or gardening even In the NHS and public health, there's a phrase which is no health without mental health. So I could be apparently well, apparently without the disease, but really in quite a poor place. And in fact, if you look at the World Health Organisation's acceptance of health and wellbeing, it's a state of complete health and wellbeing. And certainly I know many people, perhaps including my father who has Parkinson's, who is otherwise reasonably well, but sometimes can be challenged. And he has processes to overcome that. And in fact, he's a volunteer at Hampton Court Palace. And he'll tell you that distraction of being a valued member of the staff at Hampton Court Palace and taking tours is much better at reducing his perception of pain than his meds are.
And so in Green Gym, actually, our evidence that we can reduce anxiety, reduce depression, improve self-esteem, how I feel about myself globally. And actually, one of the other things is feelings of usefulness. People say they feel useful. All of those things seem to have a very strong mental impact. So now I'm more likely to be physically active. I'm more confident that it's safe for me to do that. I wanted to be part of the group as well. So Green Gym is a group activity. We're group animals.
In public health, if we're going to inoculate people, we actually refer to herd immunity. So you're a herd. And that recognises the impact. And we know that when people come together to achieve things, there's a change to brain chemistry. So you might see changes in dopamine, which can have a positive effect on how you interpret pain signals. And actually what we are seeing, and I've been doing this for a long time and so have many colleagues, really promoting the medical fraternity to go actually back to its roots from Hippocrates and Socrates, people might remember, who spoke about the benefits of physical activity, letting food be your medicine. Not discovering that, but rediscovering.
There's quite a few people who are really engaged in this process and I'm really glad that they are because you need people within the medical fraternity to drive that medical fraternity forwards. Well, just a few miles to the east of Waterloo Park in London is Whips Cross Hospital, where you'll find another green space, albeit on a slightly smaller scale. Margareta Rooney is Clinical Nurse Specialist in Rheumatology at Whips Cross Hospital. I'm Josephine Kirkkenny. I am a patient of Margareta. I'm Brian Halls. I've been a patient here for years. Margareta, I've known for years, has been treating me. Margareta took me into being a volunteer at Dudys Garden.
which I'm very glad she has got on. She kept me mobile. Margaret, just explain to me where we are. We're in a garden at Whip's Cross in the outpatients department, which has been designed for people with arthritis so that they can carry on with their favourite hobby after they've had the diagnosis. It's a model garden. It looks like a model garden. It's very well manicured, better than...
I can imagine a garden being, to be honest. Well, that's thanks to Brian and Josephine who come in here every week and give their time to maintain the plants and keep the place clean and tidy. So how did this garden start? Back in the mid-90s, a patient donated a small amount of money to the consultant David Doyle at that time and myself in gratitude for the care that they were receiving from us. We thought, what can we do that would live on forever, really? This part of the hospital had just been opened and we had a blank space.
Many patients are concerned about their ability to carry on their usual activities of living and their activities of pleasure, and one of them is gardening. So we thought we could develop a garden here for people with arthritis. Brian, tell me how you got involved in the first place then. I was walking down Snakes Lane West, and a young lady called Margareta stopped me and said, would you come and put some bulbs into the garden? She said, I have another young lady that's volunteered called Josephine, would you meet up together, which we did do, and for 15 years, what we've been doing, the garden. And of course the garden is made for arthritic people, because as you see yourself...
They're raised beds, which was thoughtful when they organised the garden. We make sure that Joseph and himself we don't have to climb anywhere. We work as a team. We want something tall, she'll put it down to the broom, I'll cut what I can. It's a social event, because sometimes you're out in the garden, people come and ask you, and they realise I've got arthritis again, and say, oh, you can do that, so could I perhaps, you know what I mean? It gets you out of bed. Because if you've got arthritis, you can lay in bed and feel sorry for yourself. And you get up, you get yourself motivated, and it's been going ever since. Josephine, how did you get involved? I had chronic arthritis, I was about 49, 50, and I also suffered with a bit of depression. And Margareta one day, she said to me,
Right, I want you to take a new interest. She didn't want me, she encouraged me. And it was the best thing ever happened to me. It took my mind off the pain. It was giving back to the hospital. It was therapeutic. It got me up and dressed in the morning, not sitting at home, as Brian says, worrying about pain. And Brian and I have been great partners, we're like friends now. I'm like the second wife, I suppose. But Margareta played a vital role in this for me. She went over the white line.
And it's a wonderful department here, the rheumatology. It's excellent. You have arthritis. Yes. And you suffer from depression as well. Yes, I did. Did the two go together? Well, I was working in a very happy job as in catering. I suppose it did a little bit. But the arthritis was very bad. It happened quite suddenly at work. And I think it all got me down in a black hole. And it really helped me. It was better than medication as far as I got medication. And I've got much better now with modern medication. But the gardening played a vital role. I was learning a new skill.
Catering was quite stressful, I suppose, and Wes. I loved it. And friendship. And people came out here socially. They would come and have a little banter with us. And all those things make you feel good. Money isn't everything. I find it so important to be thankful to our national health. And our rheumatology team played this vital role. Margareta was there for me. And I cannot thank the hospital and Margareta for all this. And Brian, my gardening partner. He's played a vital role. Margareta, how did you envisage this would help people? Well, it's well known that people's ability to cope with pain depends on...
What else do they have to think about? The more active you are, the more you're able to cope with your pain. Getting a diagnosis of arthritis is the first thing. It can be devastating. Patients in the beginning are in a lot of pain and discomfort and distress. And the aim is to get patients out of pain quickly, which we do. And now with the advent of all the new treatments for arthritis, we give these treatments very early on. So they don't have the terrible outcomes that they had 20, 30 years ago. However, many patients expect...
us to be able to give them a pill or an injection to help you know and to take the pain away but that isn't always possible some people expect medicine to help with every pain and ache but it's not like that so if you accept that this is a condition you've got whatever rheumatological condition you may have then you have to work within the limits of that the aim of my role as a clinical nurse specialist the doctor makes the diagnosis and prescribes the treatments, my role as a nurse is to help the patient to understand the diagnosis, to understand the treatment and to manage their activities of living as if they didn't have arthritis. So they have to make some adjustments, but not all the time. And that's my role, is to discuss with them how they live with their condition. If you're in pain and you, for example, enjoy dancing...
Well, we try and encourage people to keep dancing, but the patient will perceive it as not being able to do it anymore. If you're a pianist and, you know, you develop arthritis, it can be devastating for that patient. People who garden always think of the heavy digging, you know, the mowing the grass, the pruning, all that. But this is an example of a garden where you can maintain and manage easily. And that was what we put into the design. If you want to, you can sit as you do your reading, because...
of the way the raised beds are. There's no grass, but the patio looks very nice. You know, the area is quite calm and comforting and relaxing. There are lots of papers that have been written about gardening and arthritis. Arthritis Research UK have a very nice leaflet, and I've got one of them for you to take away with you, that talks about gardening and arthritis and tips on how to manage their gardening. You know, it's good therapy for any of us, even if we haven't got pain or arthritis or fibromyalgia or any of the rheumatological conditions. If you can get out in the fresh air, it's always good. Indeed it is. That's clinical nurse specialist...
rheumatology at whips cross hospital margaretta rooney and margaretta's keen to find the next generation of volunteers to carry on with the upkeep and development of the garden get in touch with her at whips cross hospital rheumatology department or us at pain concern and we'll put you in touch with margaretta and that gardening and arthritis book that she mentioned can be ordered or downloaded from the arthritis research uk website and their address is arthritis research uk no gaps arthritis research uk.org now back to the green gym chris spears works with the conservation volunteers organization developing green gyms across the uk check out their website which is tcv.org.uk slash green gym once again tcv.org.uk slash green gym and you can find out if there's one near you and if not we're here to support anyone whether that's an individual an organization a small community group to enjoy the benefits of Green Gym. So we would be very keen to help. So there's our email address is greengym at tcv.org.uk and that's the conservationvolunteers.org.uk. If you were to get in touch, we'd be happy to support you to set up a group locally, you know, make those health referral links. We have Green Gym Leadership Programme, which we offer out to other organisations, community groups, to be able to support them to take on and run Green Gym to the same standard that we run elsewhere across the UK. And we're working with communities and organisations.
all the time to do that. In the UK, over 40 of the Green Gym groups that are running presently are completely independent to TCV. So many of them were established by us, but they're run by volunteers or people from the community that come together, meet once a week, and they very much have the ownership to take their Green Gym and take that forward. And they do everything from the fundraising to managing the projects, to looking after those spaces, to buying the tools, to managing the first aid and everything else that needs to be done on the day. You mentioned the word referral. What do you mean by referral? Who are the referrers?
We talk sometimes about self-referral and referral. I mean, self-referral would be if someone heard about the programme and took a decision to come along, as I did, for the kind of health benefits of coming and participating, rather than being signposted by a health practitioner. So in order to reach a wider audience and a more diverse audience, we have for about 20 years been working very closely to proactively engage health referral partners. We work with GPs, physiotherapists, a wide range of different health professionals. not only from, you know, maybe within services within the local authority, but other charities such as MIND, such as Rethink, with people who might be coming out of prison, looking to be rehabilitated. So really a huge range. So it's a very mainstream programme and very much open to anyone to join. And we look to run the programme to have a range of activities to make it accessible for everyone.
chris spears once again the green gym website is tcv.org.uk slash green gym and don't forget to contact margaretta rooney at whips cross hospital rheumatology department if you can help support their garden or contact us at pain concern our website is pain concern.org.uk contact us there and we'll pass on your details to margaretta don't forget that you can download all editions and transcripts of airing pain from pain concerns website once again it's pain concern.org.uk and there you'll find information and support for those of us living with chronic pain our families and carers and of course for health care professionals There's also information on how to order pain concerns magazine, Pain Matters.
Now, we at Pain Concern need your help. Like all charities, we rely on the generosity of individuals and funding bodies to keep us going. Don't worry, I'm not asking you to make a donation on our Just Giving page, although you're very welcome to do so and we would never turn it down. But in order to carry on making these airing pain programmes into the future, we really need to know that what we're doing is of benefit to people living with chronic pain, your family members and supporters, and for healthcare professionals. And this is really important for us. How do the programmes we make help you help your patients? So for everybody listening, we really need your feedback.
Has listening to airing pain improved your day-to-day living? And if so, in what way? Have the programmes helped you manage your pain? How? And in a broader sense, has living with chronic pain or with a family member who has chronic pain become more manageable? And I can't emphasise too much how important it is that we also get feedback from healthcare professionals on how these programmes help you to help your patients. So do please go onto the Pain Concern website and click on the feedback button to take part in our short survey. Have your say. Without your views, we won't know what we're doing well and what needs improving.
OK, I look forward to your feedback. Now, back to the Green Gym, and Rosie Broadley will end this edition of Airing Pain. My life has changed completely. I know it sounds absolutely ridiculous. There is hope out there. There is. There really, really is. And I've got somewhere to go. Even if I don't get up and do it, I have got somewhere to go. And September, I start college for a whole year, Regent's Park, to get my landscape degree, number one. And this has all happened six months since meeting Green Gym. So life has changed completely. Thank you very much.