Chronic Pain and Mental Health: Insights from Pain Coach and Physiotherapist, Richmond Stace

Chronic pain and mental health can be deeply intertwined – and often almost as deeply misunderstood. We sat down with our Pain Coach and Physiotherapist, Richmond Stace, to glean his insight on how pain is shaped by beliefs, behaviours, and context. Drawing from physiotherapy, neuroscience, positive psychology and over 20 years of clinical experience, Richmond explains how his Pain Coaching approach supports individuals to live more fully and move with confidence.

Whether living with persistent pain, supporting a loved one, or referring a patient – this  practical, person-centred perspective answers six key questions about chronic pain and mental health.

What is Pain Coaching, and how is it different from physiotherapy or CBT For Chronic Pain?

“Pain Coaching – in the way I describe it – is a multidisciplinary way of helping people transform their three-dimensional experience – essentially the reality they experience. I’ve drawn from my background in physiotherapy, pain neuroscience, coaching, nursing, positive psychology and even Buddhist philosophy which all comes together to support someone in truly living themselves better.

Most people come to me because they’re stuck. It might be persistent pain, movement difficulties, post-trauma or even depression and addiction. They don’t often need ‘fixing’; they need support to understand what’s driving their experience and how to move forward in order to release them from their constraints.

Unlike a single-discipline approach, my method is entirely person-centred. It can stand alone or work within a multidisciplinary team. Either way, it’s about helping people reconnect with what matters, so they can start thriving again.”

If Scans Are Normal, Why Might Pain Persist? And What Does This Mean for Recovery?

“Pain isn’t something we can see on a scan. It’s not stored or generated in the tissues, so there is no investigation that can ‘show’ pain. Instead, it’s a ‘need state’ … like hunger or thirst. It’s the body’s way of asking for a change – not a ‘fix’, because there is nothing that needs fixing. Instead, the person and their needs must be understood and then met. This includes valued life goals and ways of living wholesomely.

Often, that is about understanding what’s being subconsciously predicted. Many people live in survival mode, and their systems are preparing them for a future threat that’s based on previous experiences rather than one that actually exists.

So, I focus on the person and helping them to transform their pain and suffering by transforming their life. Sessions begin by identifying limiting beliefs – the invisible constraints holding someone in pain. Interestingly, we are designed to recover, so once someone understands their pain – in terms of where it’s coming from and why – we can start creating the conditions for them to thrive rather than survive.”

What Habits Can Help Reduce Chronic Pain Flare-Ups?

“We don’t try to treat pain directly … we don’t even really want to focus on the pain. This can reinforce the idea that pain is a problem. Instead, we turn that on its head. We ask: What kind of life do you want to live?  What sorts of conditions do you need to thrive? Then we start building that life and creating those conditions.

An important insight that I always share with those I help is to focus on what you desire more of, rather than what you don’t want, or want less of, or ‘want’ as a state of being. It’s always about shifting from a perspective of lack and wanting, to one of abundance … from focusing on the negative to focusing on the positive as if it’s already achieved.

Something amazing then happens as a result.

So, for example, If the goal is to get rid of pain as an issue, and the focus is always on the problem itself – the lack of wellness or wanting to remove pain from their life – they are simply reinforcing over time that they have a problem, which is what they then continue to receive more of.

You only have a problem if you tell yourself that you have a problem. Your subconscious attracts more of where your attention sits.

Instead, we work on curating the life you want now. Many people think they must wait for their pain to get better and then they can start living, and so they simply end up waiting and waiting. Instead, we turn this on its head, and we start living the life you want now. And guess what – the body then cultivates this into your three-dimensional reality.

However, this must come after the limiting beliefs have been revealed and updated. Otherwise, it is like trying to mow the lawn when you’ve locked yourself in the shed from the inside, with the mower and grass on the outside.

Key practices include learning to be present, cultivating a calm mind and inner peace, and movement. These are essential for transforming pain by watering the right seeds. When the person spends more time in good and great states – ones of joy, love, compassion, gratitude – there is less and less reason to be in a protected state.

The bottom line is that the more you focus on the thing you want to get rid of and try to ‘treat it’, the worse the outcome. The more you focus on the person living their best life, the better the outcomes. And this concept can be applied to anything you desire in life.

How Do You Help Someone Overcome Fear of Movement?

“The first step is understanding. Once someone truly sees that their pain doesn’t mean damage, they have divine trust in that they are safe, and so the fear starts to fade. This is a change in beliefs in action.

Every cell in your body needs movement – it’s essential. But we don’t throw people in the deep end; we very much meet them where they are.

We listen.

We individualise.

We honour the way they move today, while guiding them gently toward what’s possible next.

This is part of what I mean by living yourself better. It’s not about just pushing through fear. We must reframe this, to a perspective of dissolving it through trust, clarity, and experience.”

How Do You Support People in High-Pressure Roles Where Performance, Travel or Sleep Are Impacted by Pain?

“We start with awareness, examining their role and what they are convincing themselves to be ‘true’ about it. It then becomes clear which elements of their life are contributing to their pain … and suddenly they then have choices appear in front of them.

To transform your pain, you transform your life, and vice versa. But this means that there is always a reason for chronic pain. It’s asking you to make a shift which you either listen to and make positive change, or ignore and take your chances.

I am always very upfront about this concept, because not everyone is ready to make a change … and that’s fine!

When this choice is made, one makes a conscious decision knowing the consequences and the possibilities available to them. I respect autonomy because they are the experts in their life. I am just a guide.

When I work with someone, we make it work for them based on their commitment.

It’s not ‘pain management’ as such. I like to think of it as a focus on positive transformation. Freedom, inner peace, and simply living well.”

How does Pain Coaching Integrate with Mental Health Support?

“My unpopular opinion is that I don’t use the term ‘mental health’, because it implies separation of the mental from the physical, which is not the truth. There is no real division – in reality, there is one experience. What we call ‘anxiety’, for example, is just the brain predicting and focusing on a future that doesn’t exist based on a past that’s gone, and protecting them from it … even though it’s not happening.

You can start to see how beliefs can be both so powerful and limiting when the individual is constrained by them.

So, the above example could equally be ‘pain’ as the experience. We explore the beliefs that the person holds about why they are anxious or depressed that tie them to those states as their reality. Perhaps we learn that they need therapy, but they’ll definitely need more movement and engagement in activities they love, and learning how to live wholesomely. In fact, these can often provide the foundation for the therapy that ensues.

Frequently when working in a team, I focus on these elements, which provides a safe space for the client to talk openly. I simply listen as they tell me about their week, I have unconditional positive regard for them, and listen deeply. Being present with someone is an act of love and compassion … from which healing happens. I also often use PSEQ as a measure of success, however the main one is whether the person practiced in the best way according to their needs of that moment in time. That is since there is no ‘past’ and no ‘future’ – only the present moment. And when we learn to be present, truly present, then we begin to unravel the skills needed for miraculous change.”

Pain coaching reframes recovery as a creative, personal, and collaborative process. Not a treatment to be done to someone, but something they learn to live.

Whether a patient, professional or parent, the invitation is the same: listen deeply, move gently, and ask what your pain might be calling you toward.

If you’d like to explore how pain coaching could fit into your recovery or clinical care model – contact us to find out more.