This is the first post in what will be a series about “re-thinking pain”, or rather, re-conceptualising it.
The aim of the series is to help you move from a tissue based understanding of pain to one based in neuroscience, which is more accurate and more correct (although a better term would probably be “less wrong”, as there is still so much to learn).
Why is this necessary?
- The language we use around pain shapes the way we think about, and experience pain. Using tissue based descriptors of pain reinforces the idea of a “bottoms up” model of pain, which is wrong, and can often make things worse in the long term. Moving towards a neuroscience approach helps move away from this model.
- Chronic pain is a massive problem in Australia (and around the world), affecting millions, costing billions and growing worse every year. Chronic pain often starts as poorly managed acute pain. One of the most important management strategies of any painful condition is education.
To begin to understand how we have ended up with such a problem regarding pain requires tracing back through the centuries of medical and philosophical history.
In short, we used to describe pain as “coming from the tissues” up to our brains, where we felt it.
What is now understood, is that pain is a brain output, with many different “filters”, that are unique to each and every one of us, being applied before we are consciously aware of it.
Despite having this knowledge, we can see that even within the official definition of pain, the problem exists.
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
The definition of pain above has been put together by a group of highly intelligent people (International Association for the Study of Pain), who have spent a large portion of their lives studying pain, it’s effects and how to treat it.
Unfortunately, there is one small problem, and it has nothing to do with the definition itself, but rather, the fact that pain is “described in terms of such damage”.
When we explain all pain in terms of tissue damage we paint a picture in people’s minds. Unfortunately, when it comes to pain, this picture is not only incorrect, but harmful.
One can assume this became part of the definition because of what takes place in the real world:
- Your back hurts, people say you have strained a ligament/joint.
- Your knee hurts, people say it must be arthritis.
- You have a headache, must be wear and tear of the head. No, that last one doesn’t sound quite right.
So how exactly is this harmful?
When pain is described in terms of body tissues alone and combined with the type of language typically used (words like torn, strained, scarred, degenerative) to describe tissue based pain, irreversible damage in the form of nocebo* can be caused.
This can lead you to think that something is wrong with your body that needs to be fixed, when things are in actual fact, completely normal.
Additionally, thinking in terms of body tissues leads to a mechanistic view of the body, one that wears out over time and the association of this “wear” with pain. The body is a biologic organism, one that is always adapting as best it can, it doesn’t “wear out”, but rather fails to adapt. There are lots of reasons for this failed adaptation though, it’s not just the result of “getting older”.
Check out this Facebook post on from September:
*Nocebo, is basically the opposite of placebo, ie causing harm when no harm has been done.
We need to rethink pain, to conceptualise it as a dynamic process, arising in the nervous system and governed by our brains.
Yes, pain is often a result of tissue damage. However, there are many cases of severe tissue damage with no pain experienced at all and vice versa.
Additionally, the intensity of pain is very poorly correlated with the severity of any tissue damage.
Finally, when tissue damage has occurred, there are three scenarios.
- It is quite severe and needs medical intervention at a hospital. Think of compound fractures, 3rd degree burns, deep cuts etc.
- It is not severe enough to require medical intervention beyond basic first aid.
- It is somewhere in the middle.
In all 3 cases, with time, the body will heal as best it can.
As long as there is adequate rest, nutrition and then re-loading of the tissues in a progressive manner as governed by the condition and individual requirements, you’ll get as full a recovery as possible.
So initially, once the need for medical intervention is ruled out, the important thing to do is treat the pain.
This goes against almost all manual therapy and allied health advertising to “treat the cause of your symptoms”.
Alleviating pain will, in many cases, sort out a lot of associated “findings”, the so called causes of your pain, and then beyond that, allow your body to heal.
If you came to us for treatment, here’s how we might do that:
- Explain all of this information about pain, in a way that makes sense to you, so that you aren’t as stressed or anxious about it anymore.
- Have a look at you stand and move and suggest ways that might make standing and moving less painful.
- Get hands on and apply some really pleasurable manual techniques. There is no need to dig in deep for the sake of it. The goal isn’t to change the tissue, it’s to change the perception and get the brain releasing pain relieving chemicals.
- Do some breathing techniques to help you relax. You’d be surprised at how poorly most people breathe, even when they are concentrating on doing it properly.
All of these techniques are based on the same principle – once the threat is reduced to an acceptable level, the brain will stop protective behaviours, which include pain and altered movement.
So to summarise a blog post in a sentence:
Pain is all about threat perception, it doesn’t mean damage and body tissues can’t produce pain, only the nervous system can**, so we must focus on the nervous system, including the brain, when describing and treating pain, so as to not cause further complications via nocebo.
**Yes, the nervous system is a body tissue, but for the sake of the argument we are using simple language.
This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.
Integrative Osteopathy is an osteopathic practice located in the heart of Fitzroy North, within the reputable Healthy Fit gym. For all inquiries, call 0448 052 754, or to make an appointment online, click here.
This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.