No tags yet.
(Many of the concepts I've tried to outline here are discussed more deeply in this extremely good blog post: https://thelogicofrehab.com/2017/09/11/pain-science-guiding-the-path/)
It's simple: Pain hurts. Pain meds help, right?
Well yes and no. The area of pain science has been evolving steadily and many seemingly intuitive things turn out to be not so simple.
Pain is obviously not something you ever wish to have even though it does play an evolutionary roll in keeping us safe and stopping us damaging our bodies.
The traditional view of pain has been:
- Stimulus applied to body part.
- Body part recognises this as bad
- Body part sends "PAIN" signal to brain
- Brain reacts. "OUCH!"
It turns out that this is an overly simplistic view and the process is more like:
- Stimulus applied to body part
- Body part recognises "Stimulus"
- Body part sends "STIMULUS" message to the brain. ("Something is happening")
- Brain receives "STIMULUS" message and decides if this is good, bad, how to respond etc.
(Notice in the 2nd example there is no automatic "judgement" about the Stimulus.)
You might have guessed that this changes the idea of pain as a simple input from the body part into more of an output from the brain and this in turn opens up our experience of pain to all the other things that influence our brains...stress, expectation, phobias to think of a couple.
This has lead to the most up to date model of pain being termed the "BioPsychoSocial" model describing how pain has a Biological element (actual physical stimulus/damage), a psychological element (your mind set) and a Social element (your biases, expectations etc). These 3 all interact with each other as well.
So we see, this rabbit hole is a LOT deeper than it first appears, especially with chronic pain.
Chronic pain is especially complex as it tends to have less to do with tissue damage and more of the psycho-social elements. On the other end of the scale, if you trip down the stairs and break your arm, that's acute pain and that's likely the biological element screaming at you, almost regardless of the other 2 elements!
The biggest take away from this new model is that often Pain ≠ Damage, especially in the setting of chronic pain. This is backed up by studies showing how there are both huge groups of people walking around with chronic back pain, and no abnormalities after being MRI scanned, AND people with obvious abnormalities (bulging discs etc) but zero back pain! In fact as we get older most of us will have bulging discs, it's just a fact of ageing. Whether that corresponds to pain or not is not so clear.
Why is thinking this way useful?
1 Avoiding the NEED to find a physical diagnosis for chronic pain.
I am very much that guy that thinks mechanically, and I've had to train myself that "pain" does not equal "mechanical problem". I have finally realised I'm not a car made up of parts! Avoiding the need for a diagnosis will likely also avoid a slippery slope of physios, chiros, massage therapists, biokineticists and eventually doctors and potential over-diagnosis and drugs. This will hopefully reduce the chance of using opiates for pain as well.
That path can also extend to complete wastes of time like reflexology, homeopathy, essential oils and who knows what else (I could keep going for days, but I do want to retain SOME friends).
2 It allows you to stop catastrophising.
Realising that "Pain" does not necessarily equal "Damage" frees you to relax and realise it's just pain, and you're probably fine. You probably don't have whatever the latest "syndrome" is that runners get or that stops people from lifting anything off the floor. You probably will be fine and it'll probably go away on it's own.
3 You don't have to stop doing stuff.
Often chronic pain is psychologically linked to some movement. You "tweaked" your back picking something heavy up. Now you are fearful every time you need to bend over and lift something. Your movements become guarded and you become hyper-focussed on the area, causing you to feel everything more acutely....a classic vicious cycle.
This fear can become more debilitating than the actual pain after a while and can severely impact your life.
Realising that bending over will not "destroy your spine" frees you to start moving again....which, ironically, is often the best thing you can do for most aches and pains. The difference this can make to quality of life is actually staggering....seeing someone go from "I can't play with my grandkids anymore" to rolling around, rough n tumbling with them on the floor for example! (Amazing video on back pain!! https://youtu.be/dlSQLUE4brQ )
All of these things promote self efficacy and autonomy!! You no longer have to rely on an external source to manage any pain you may have. An internal locus of control is a great and powerful thing to have.
Personally, this way of thinking has absolutely changed my life for the better. In the past, pain was obviously a signal of something "wrong" and I would obviously stop doing things to prevent further pain and what was obviously more damage to my body....right? Not so obvious!!
Realising that I can work around chronic pain, and regain self efficacy and keep doing the things I love to do, without having to pay anyone to tweak/stretch/poke/beat me, is extremely freeing.
If you do need to see someone about pain, try to find someone who treats you as a human being and not a machine that has something "broken" and needs to be "fixed".
A note for coaches, clinicians or anybody trying to help people with pain:
Remember that the words you use with someone when talking about pain can influence them (psychological element). Just as the Placebo Effect can have positive influences, the "Nocebo" Effect can have negative consequences. For example, telling someone "Squats are really hard on your knees"... How often will that statement end up with someone having knee pain from squatting? "Deadlifts will destroy your spine", using words like "explode" or "destroy", telling someone they'll "never again *activity they love*" etc. These things are often not helpful and put the pain sufferer in a negative and fearful mindset right from the get go.
From The Iatrogenic Potential of the Physician’s Words study:
“Some of the information that physicians convey to their Patients can inadvertently amplify patients’ symptoms and become a source of heightened somatic distress, an effect that must be understood by physicians to ensure optimal management of patient care. This effect illustrates the iatrogenic potential of information, as opposed to the iatrogenic potential of drugs and procedures. Somatic symptoms and underlying disease do not have a fixed, invariable, one-to-one equivalence. Symptoms can occur in the absence of demonstrable disease, ‘silent’ disease occurs without symptoms, and there is substantial interindividual variability in the symptoms resulting from the same pathology or pathophysiology. One mediator of this variability between symptoms and disease is the patient’s thoughts, beliefs, and ideas. These cognitions can amplify symptoms and bodily distress. Although cognitions may not cause symptoms, they can amplify, perpetuate, and exacerbate them, making symptoms more salient, noxious, intrusive, and bothersome.”