Please note: This story includes mental health issues.

1News reporter Sam Olley was living a typical 20-something's life in Wellington, with a fast-paced career and intense exercise regime, when severe neck and shoulder pain knocked her into a bewildering place. That is chronic, debilitating pain that persisted after the injury healed. In her recovery and return to work, Olley discovered surprising truths and the latest neuroscience around the brain's crucial role in our experience of pain. And with one in five New Zealand adults living with chronic pain, the findings are striking.

Embracing physical endurance

My younger sister and I weren’t brought up to shy away from pain, but to embrace it, mainly in the form of endurance sport. Mum is a former Coast to Coast teams race champion. My sister was a junior New Zealand rower who would push herself so hard she'd vomit. In one infamous race, with thousands watching on, she exerted herself so much she passed out in the middle of Lake Ruataniwhā. My own triathlon training was often a mental game spent in what athletes called the high-intensity "hurt box”, with heart-rate max tests that brought my BPM above 200.

For the men in my family, pain came mainly via risky farm machinery and bad luck. Both my father and grandfather are missing fingers from accidents – my grandfather losing his in dry Central Otago grass, pruning pinot grape vines. My dad, explaining his cracked stumps to me as a curious child, simply said the fingers he lost before I was born had been “in the wrong place at the wrong time”.  

But my shoulder and neck pain couldn’t be explained by extreme sports or rugged rural adventures. I was living an urban life, working as a TV journalist, going to the gym and running to deal with stress and, as it turned out, overdoing it. For weeks on either side of surgery for a stomach hernia, I struggled to eat and sit up straight. And that overloaded my neck. 

At least that’s the theory, but the truth is, by the time I’d gone through all the confusing referrals and appointments for my neck pain, the initial tissue damage was six months behind me and could only be guessed at. Its location was eventually put down to my cervical spine, and a nerve radiating to my right shoulder. My sports doctor had recommended her old physiotherapist in Wellington who became my rock, talking me through teary consults. 

An anxiety link

My own inconvenient derailment makes sense when I look back. Amid a stack of stress – with media job cuts happening everywhere, a break-up, building work at my house, and the hernia making it hard to eat solid foods – I found myself sleeping badly and overexercising to clear my head. Some physical changes happened: my resting heart rate would drop as low as 45BPM to conserve energy, but would then start racing too, when I was anxious. Large tangles of hair fell out when I ran my hands through it. My ears rang all the time. A blood test showed I had hypothalamic amenorrhea, meaning my reproductive hormones had shut down temporarily because my brain thought I was too unhealthy to risk becoming pregnant. And at the dentist I learned I’d been grinding my teeth in my sleep and had cracked a molar. I had to start wearing a night mouthguard to protect the enamel. And then came the neck and shoulder injury.

Because central sensitisation – the central nervous system making someone more sensitive to pain – is linked to anxiety, I can see why my brain then saw a need to protect me. It stopped me in my tracks with an overreaction of pain, even after the injury healed.

After four months my discomfort began to make each day feel intolerable. I was too sore to work and every day I worried I would just keep suffering for decades. I’d visit my 91-year-old grandfather (the one with eight fingers) and privately wish to swap places with him, so that I’d only have a few more years struggling with my body.

It freaked my family out, and at one point last year my mum and aunty stayed with me on rotation for over a month. Mum would sometimes read on the floor of my bedroom until I fell asleep, like when I was a baby, but at 29. When we ended up in the ED waiting room together on Mother's Day, a nurse grabbed my hand, looked me in the eyes and said, "you need to remember that life is precious". She pushed down on my palm for the final three words for emphasis. I clung to that.

One in five Kiwi adults in pain

Accessing well-informed pain services is incredibly hard. It's an international problem. Moseley told me the most common ailments humans face internationally are lower back pain, followed by depression, and then chronic neck pain. But in Australia he says, the funding for chronic pain is a tiny fraction of that allocated to depression and the wait lists are long.

In New Zealand’s regional public pain services, the situation is similar. In the 2023/24 New Zealand Health Survey, one in five New Zealanders aged over 15 lived with chronic pain at various levels, with women, Māori and those living in areas of high deprivation at higher risk. But we have an extreme shortage of specialists, and spaces for patients. Te Whatu Ora indicated that in the year spanning 2022-2023, 3451 people received an initial appointment with a specialist pain service. That’s less than 1 per cent of those recorded with enduring high-impact pain.

Last year, in the Capital and Coast region I live in, patients waited an average of 237 days before being seen by the regional pain service. The 997 patients who were seen in 2023 had an average of 3.25 hours of direct contact with staff over the entire year. In nearby Whanganui, patients have been waiting about 105 days to be seen, but the contact time is even less, with an average of 20 minutes each for the entirety of 2023. That's for a condition that, for many, is experienced all day, every day.

I was only considered bad enough for a referral in Wellington, after multiple ED visits. That was in May. I got a call in September to complete a long pain service questionnaire. Then came a letter in October to say there was a further significant waiting list and Te Whatu Ora apologised for the delay.

I suspect, and hope, that by the time I’m seen I’ll be mostly recovered. That would be a joy but one that’s come at a big financial cost. My parents paid over $10,000 in private specialist care bills last year. (That was a psychiatrist, a pain psychologist and pain counsellors; as well as some ACC-subsidised GP, physio, MRI, X-ray and ultrasound appointments.)

Then there was my lost income, over the four months I was off work or working part-time, but without long-term ACC cover. I'm incredibly lucky costs were not a barrier to me getting private, expert care, but many who need this cannot afford it and their condition worsens.

The risky quick fixes 

The more accessible practitioners like GPs and ED staff sometimes prescribe quick treatments with short and long-term risks, to reduce distress in the present. That's how I ended up cycling through a concoction of pills. Recently I saw a list of the ten drugs most commonly linked to overdose deaths in New Zealand and realised that last year I was prescribed five of them.

I opted primarily for gabapentin for long-term use. Some side effects like water retention and a puffy face were minor and superficial. The cognitive effects were harder to take. I had a groggy brain running at about what felt like 50 per cent. My facial recognition was bad, my sentences jumbled. I had short-term memory loss. Sometimes friends looked at me quizzically thinking I was taking the p**s with my annoying humour – but it was actually me trying my best. Basically, I couldn't rely on my brain for a while. I felt drunk all the time, disoriented and detached.

Those side effects were still less scary than those of long-term reliance on opiates  – codeine, morphine, tramadol, fentanyl and more, so often prescribed to help people with persistent pain, who then get addicted.

In North America the terrible toll of the opioid epidemic is well documented. In 2022 The Lancet called it "one of the worst public health disasters affecting the USA and Canada” and estimated nearly 600,000 people had died from an opioid overdose in 20 years.

An added cruel complexity is that both animal and human studies have shown long-term opiate use can lead to heightened pain sensitivity or opioid-induced hyperalgesia.

Moseley says he understands when a GP doesn’t have time for biopsychosocial care – that is, the recognition illness can be influenced by psychological and social as well as biological factors. They have a 15-minute slot.

They’re also not specifically trained to understand the bewildering complexities of pain. Moseley says most medical training programmes include mere hours looking at the topic. “But pain is the most common reason someone sees a health professional,” he says. “It's crazy."

So, what does he say to someone who has hit rock bottom and feels unfixable? His suggested reply: "It makes sense that you feel like you're at the end of the rope... You've had pain for years, you've had heaps of false hope, you've had a whole lot of treatments that didn't work, you have your mates sick of you, you have your family ready to get rid of you, you have your job lost... But there is a way out of this. Would you be open to learning about that?"

The slow road back

Those who say “yes” often end up going back to basics. Decent sleep, meeting nutritional needs, meditation, reducing stressful responsibilities, having supportive and calming relationships, gentle exercise, and relaxing fun habits, all of which is linked to our brain chemistry. I bought and read so many second-hand books I ran out of shelf space. I cuddled my family’s and mates’ patient pets. I walked on the bustling waterfront every day or in the Mt Kaukau bush, despite the wind or rain or mud, and I listened to lots of music  – I mean, Spotify sent me a notification in December to say I'd listened to 185,312 minutes of music in 2024.

And then there's a clincher, gradual exposure. Doing things that trigger an increase in pain in tiny increments each day – gradually training the brain that you can do more, without danger.

After six weeks off work, I returned to three half-days a week, then slowly built up by half-days to a full-time week. I would do deep-breathing exercises at my desk – which freaked out the poor sports reporter beside me. If it got too much, I would have a few tears in the voice booth, the toilet or the make-up room, splash water on my face and try again. I aimed to do five minutes more computer work each day, even if it was just reading a screen. The plan worked. And it’s similar at the gym. By December 2024 I got to using 3kg weights for exercises that in 2023 I could do with 12kg. But I’m now confident I’ll get up there again.

When pain flaring was really bad, I would cope by overwhelming myself with a different feeling – even a different type of pain. Like lying on a spiked shakti mat in the lounge by the fire. Or dousing myself with a cold shower then sitting in a 90C sauna for as long as I could, going back and forth for an hour.

Then there's the part of the Titanic turn, when you’ve stopped getting worse, but you haven't really got any better. You’re at the bottom of the U and feel stuck.

Moseley says: “We’ve done a lot of research with people who have recovered from chronic pain. What skills were most important? Patience, persistence, courage to keep going. And for the health professionals, what's the thing that you think your patients need the most? Motivation, reassurance, understanding.”

And he says that the vast majority of the time: “When you flare up, know that you haven't rebroken. Did something big happen without you knowing? Like a car accident, you fall over, whatever? If the answer is no – then did you all of a sudden do more, way more, than you would normally do? And if the answer to that is no – then we can be very confident that your flare-up is protecting you. You haven't damaged anything.”

When my meditation teacher told me I was “ahead of the curve of persistent pain recovery” I thought he was joking, the time had felt far too long. He then reiterated "pain is inevitable – suffering is optional".

Credits

Words
Sam Olley

Commissioning Longform Editor
Emily Simpson

Design
Vania Chandrawidjaja