SIRPA 2025 Reflections - Getting Uncomfortable

I attended the SIRPA (Stress Illness Recovery Practitioners’ Association) 15th Anniversary Conference on Saturday. Having never been to a SIRPA event, I wasn't sure what to expect from the day. The programme was promising, with a variety of expert clinicians and lived experience experts billed to offer their insights'. Happily, the day far exceeded my vague expectations at outset.

SIRPA was founded by UK Chartered Physiotherapist Georgie Oldfield in 2010

There aren't many conferences where speaker after speaker delivers an exceptional talk, each offering something unique and valuable. The talks layered on to and complimented each other over the course of the day, the end result being an optimistic offering of how care for people with persistent pain and other stress related conditions like chronic fatigue syndrome, irritable bowel syndrome and interstitial cystitis can be improved.

The  biopsychosocial approach to clinical practice makes many clinicians uncomfortable.

Biomedical vs Biopsychosocial

Medicine traditionally follows a biomedical model which works brilliantly for many health concerns. If you've broken your femur (thigh bone), you need clinicians who can identify the issue in the tissue and treat it accordingly (likely surgically with a big nail to bridge the break and allow the bone to heal). However the mechanic like approach doesn't work very well when the issue is more related to brain processing than tissue damage.

Irritable bowel syndrome (IBS) is a good example of this. Dr. David Clarke is well qualified to speak on this topic, having practiced gastroenterology for 35 years. On Saturday he underscored the fact that in cases of irritable bowel syndrome, whilst the intestinal muscles may not be functioning normally causing symptoms like pain, bloating, constipation and or diarrhoea, they appear normal when examined via endoscopy or radiology. There is no organ disease or tissue damage that explain the symptoms, because the tissue itself is not the issue. We also know emotional stress contributes to IBS. For more on IBS - see here.

Unfortunately, clinicians can get uncomfortable discussing emotions and stress as contributors to physical symptoms with the people they treat, even when they are aware that this is the case.

Gigi's Story

Gigi Cockell recounted her experience of exasperation as she saw her endocrinologist after having worked out for herself the contribution her brain had on her symptoms and after having used this insight to recover. To her surprise, when telling her doctor how she had recovered, the doctor advised her that they had known the mind was a large contributor all along. For more on Gigi's story - see here.

Why hadn't the doctor discussed this with Gigi? In all likelihood, because they didn't feel comfortable discussing psychosocial contributors to physical symptoms with the people they treat.

This is not an entirely unreasonable apprehension. People seeing healthcare providers can perceive they are being dismissed during conversations about the psychological and social contributors to persistent pain and other chronic conditions. People feeling they are being dismissed during these conversations is also understandable, especially given people do, for example, experience being dismissed as anxious by healthcare professionals when they have tissue related pain drivers, an experience sadly particularly common for women.

However in cases such as Gigi's, when the understanding of how stress contributes to symptoms are essential for recovery, clinicians have an obligation to enter into that discussion with the person they are treating. The consequences of not doing so are potentially far more uncomfortable for the person they are treating. One of the diagnoses Gigi overcame with a brain based approach was interstitial cystitis (bladder pain related to brain processing gone awry). The most extreme tissue based treatment for interstitial cystitis is bladder removal.

Changing Zeitgeist

Resistance still exists to a holistic biopsychosocial healthcare approach. There are justified concerns about paradigm over correction and the misuse of psychological and social contributors to justify insufficient biological clinical reasoning. Nonetheless, the underutilisation of a balanced biopsychosocial approach is resulting in unnecessary suffering, as Gigi's story makes plain.

Something in the air does seem to be changing. In SIRPA's 15 year history the recognition of stress and the brain as a crucial contributor to many pain presentations is growing amongst the public and healthcare professionals alike. This is thanks to the tireless work of many brilliant researchers, clinicians and people with lived experience sharing their stories of recovery.

Collaborative working in good faith between researchers, clinicians and people living with or who have lived with pain conditions is the most promising path to navigating the uncomfortable uncertainty associated with many of these complex conditions and reducing unnecessary suffering for all.