How To Overcome Recurrent Pain

 I have a bad back.

People often say that when they come to me with recurrent low back pain.

You could replace back with knee, hip, shoulder, elbow or any other painful body part.

I’ve heard it all.

But I’m here to dispel the myth of bad body parts.

There’s Usually A Reason

It’s impossible to determine cause and effect in a complex system.

But when people tell me there was no reason for their pain, I dig a little deeper.

What usually emerges is that something had changed before the onset of pain.

Of course this doesn’t mean that change is the cause of their pain, only that something changed.

Sometimes this change occurs so gradually, it’s barely perceptible.

Pain Is Protective

Usually, we will feel pain before we have done anything serious – as in injury.

Pain is a protective output of the brain.

It is generally a good thing, that keeps us safe, but it can become a problem in and of itself.

When you experience pain it usually means that your brain is trying to protect you .

You feel pain in a body part, but your brain is trying to protect you as much as it is trying to protect your sore body part.

After all, you are what’s important to your brain. Without you, it ceases to exist.

The Recurrent Pain Cycle

Recurrent pain cycle

What we can see is a pretty typical cycle for many people.

The problem is, they never get better until something breaks that cycle.

As you can see, something is missing. Change.

If we could create meaningful and lasting change, maybe we would have less recurrent pain?

Resilience and Adaptability

Resilience is not about being strong, though that is a component.

Resilience is able being able to withstand a variety of stressors.

Adaptability is about being able to responds to a variety of stressors.

These stressors can be physical, psychological, environmental or whatever else.

How do we develop this?

Desensitise

Graded exposure is a psychological technique.

It involves exposing yourself to situations that scare you, in a manner that allows you to control your fear.

Over time, you become less fearful and can increase your exposure.

Often pain is associated with movements, social settings or other contexts.

By applying the principles of graded exposure to pain, we can desensitise your response to certain contexts.

Desensitising is the first step to breaking the recurrent pain cycle.

Optimise Your Senses

Having limited sensory input can affect pain.

Sensory input is the information your brain receives from nerves throughout the body. This can be from muscles, tendons joints and organs.

When the brain receives better sensory input, it can better interpret each situation and respond accordingly.

There are 3 main impairments to sensory input relevant to osteopaths:

  1. Past injuries that haven’t been completely rehabilitated
  2. Soft tissues and joints that are stiff and/or immobile
  3. Under-stimulation due to lack of use

Improving your sensory input improves your adaptability.

Yet, even with perfect sensory input, you can only adapt as much as your health allows.

Adaptability isn’t only a neurological attribute.  Or even a physiological attribute.

Adaptability is a human attribute.

Load: Progressively and Contextually

Loading develops resilience.

But, if you are not adaptable, then you can only load so far before you break down.

This is why we seek to enhance adaptability and resilience.

Loading about more than lifting weights.

It is about challenging yourself across a variety of environments, contexts, movements etc.

Remember, resilience is not only physical.

Resilience, like adaptability is a human attribute.

Humans are physical, psychological, emotional and spiritual.

It is important to development resilience across all the entire human spectrum.

Conclusions

Recurrent pain is a form of chronic pain.

People often don’t consider it chronic, because it isn’t constant.

To break the recurrent pain cycle, you need to identify why your pain is recurring.

Then you need take the necessary steps to change.

This can be hard, which is why you should get help along the way.

Only when you create meaningful change will your pain change in a meaningful way.

 

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

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.

 

 



 

 

Pain Is A Mystery, But How Do You Solve It?

Puzzle

It is easy to think of pain as a simple puzzle. Find the missing pieces, put it all together in the right order and then voila, you feel better.

Unfortunately, as much as we’d like things to be this simple, it’s not the case, and pain is more like a mystery.

Allow me to let Malcolm Gladwell explain (1):

The national-security expert Gregory Treverton has famously made a distinction between puzzles and mysteries. Osama bin Laden’s whereabouts are a puzzle. We can’t find him because we don’t have enough information. The key to the puzzle will probably come from someone close to bin Laden, and until we can find that source bin Laden will remain at large.

The problem of what would happen in Iraq after the toppling of Saddam Hussein was, by contrast, a mystery. It wasn’t a question that had a simple, factual answer. Mysteries require judgments and the assessment of uncertainty, and the hard part is not that we have too little information but that we have too much. – Malcolm Gladwell

Although it seems like there a new discoveries about pain being published almost monthly. So much about is still unknown.

And, because pain is invisible and has many unconscious components, we simply cannot know why you, or any individual is experiencing pain at a particular moment.

The Case Against Diagnostic Imaging

You would think that being able to visualise the structure of the body would be helpful to clinicians treating pain.

It turns out that this isn’t quite the case.

Firstly, there is a large, and growing, body of research that shows there is very poor correlation between the structure of our bodies and symptoms of pain.

From disc injuries (2) to degeneration (3)  and even partial or full thickness tendon tears (4), most of us are walking around with structural “damage” that would show up on diagnostic imaging (X-ray, CT, MRI etc).

Secondly, and most interesting to me, is due to the fact that the interpretation and reporting on diagnostic imaging varies wildly.

In a recent study on MRI reporting and interpretation (5), a woman with low back pain and neurological referral was sent for an MRI at 10 different locations. The results reported 49 total findings, with not one interpretive finding consistent across all 10, and only 1 finding consistent across 9 of the 10 reports.

This means:

  1. MRIs require skill to interpret, and not all radiologists are equally skilled, thus, it matters where you get an MRI done.
  2. Radiologists working in isolation from the patient, are assessing an image, not a person, and have to make a lot of assumptions, even with a comprehensive history.

What About Physical Assessments?

Physical assessments are a necessity for clinicians, but which assessments are valuable, and which just add confusion?

We can break physical assessment into 3 components:

  1. Vital signs like pulse, blood pressure and breathing
  2. Neuro-orthopaedic examinations that are designed to rule in or rule out specific pathology or conditions
  3. Functional assessment designed to determine an individual’s movement competency and capacity

It is the third area which is the most “grey”.

This is because human movement, being an emergent property, is not an easy thing to classify (6).

We can define good and poor movement, but again the definitions are somewhat arbitrary, and their are many exceptions who fall outside those defined ranges who do not have an consequences (injury, pain etc).

This isn’t to say their isn’t such thing as good movement, bad movement or better movement, but only that it is person specific.

So if we use a movement assessment to gain insight to a person’s movement at that moment in time, in those conditions (in the clinic for example)then we can look for a movements that can be better.

If we identify movement that could be better, we can challenge to brain to improve movement, with a variety of techniques.

Even Histories Can Be Misleading

A good clinician will help someone in pain by creating the right context, or environment for them to heal.

To do this, a good clinician will know what they need to know, and more importantly, what they don’t.

By focusing only on the important, relevant, information, a good clinician minimises the chance of nocebo, and maximises the chances for recovery.

What exactly then does a good clinician need to know?

Is this pain dangerous?

When consulting with a patient, first, we want to rule out risk – some musculoskeletal pain can be caused by serious pathological conditions that need medical intervention. We have to rule these out first, and when in doubt, err on the side of conservative.

As a caveat to the above section on imaging, an “unnecessary” X-ray is a small price to pay if the alternative is missing an early cancer diagnosis. This does not mean imaging should be routine!

Is this pain affected by movement or position?

Mechanical pain is characterised by changes related to movement or position. If the answer to this question is yes, this rules in mechanical pain as a diagnosis. This does not yet rule out other origins of pain.

We can follow this up with more exploratory questions around which movement or positions feel good and which don’t.

Combined with the assessment findings, this will give us some more insight into how to proceed with treatment.

What is your current autonomic state?

Your autonomic state says a lot about you.

If you are wound up tightly – in a sympathetic or stressed state, characterised by elevated heart rate and blood pressure, shallow breathing and decreased blood flow to the periphery of the body (including the skin) – then it will be hard to resolve your pain until you enter a more balanced autonomic tone.

What are the barriers to recovery?

These are often implied, and a good clinician will be able to identify these as much from what a patient doesn’t say, as what they do.

Factors that can affect recovery include:

  • Age
  • Disease
  • Nutrition
  • Thoughts
  • Comorbid conditions – anxiety, depression, high blood pressure etc
  • Medications
  • Family and friends
  • Employment, or lack thereof

As always, it’s not simple, and it’s definitely not linear.

We are, after all, dealing with people – you know, those confusing, irrational beings who like to “go out”, but not for too long, because then they have to “go home” (Seinfeld reference, video below).

The Downside of Irrationality

Human beings are irrational. This is a fact.

Being irrational has positives, the most obvious being love.

Love is a fantastic human emotion that is completely irrational. If we were completely rational beings, then we wouldn’t spend so many of our resources chasing love, or any feeling for that matter.

But, this is exactly why too much information does not help us treat pain.

Too much information can lead us to make false assumptions and draw erroneous conclusions.

This doesn’t help patients seeking help for pain at all.

Pain has very tenuous links to tissue damage, body structure, posture, strength, symmetry and stability. (8,9)

Investigating these to a high level, and then describing pain as a result of these findings is not only inaccurate, but also harmful. (9, 10)

Every time someone is told their pain is the result of the above findings, a link is made in their brain. This is called a neurotag. Think of it like a storage file in the brain. (11, 12)

If a clinician, family member or friend tells someone with low back pain they lack “core stability”, then this is added to the low back pain neurotag.

Then, because of the way our brains function, when we have existing knowledge, we look for examples to confirm this knowledge – this is called confirmation bias.

So the person with low back pain, who has been told their pain is caused by a lack of core stability, finds “evidence” to support this.

If their back hurts when they lift something, they blame their lack of core stability. If their back hurts after activity, it’s core stability’s fault.

They forget to focus on the times that they lifted something without pain, or that activity didn’t hurt.

This is just one simple example. There are many others like it.

Conclusions

Mysteries are interesting to us as humans – as long as we get closure and the mystery is solved in the end. This is the basis of the “open loop”*  TV shows, movies and books use to keep their audiences engaged.

Unfortunately life is not like a movie. We don’t always get a neat and tidy closure.**

The challenge facing any clinician, when we treat people in pain, is to focus only the important and relevant information, and to educate patients on why this is so.

The even bigger challenge, is helping patients face the reality that the mystery of pain can’t always be solved, no matter how much (or little) information you have.

 

*An open loop is used by writers whereby earlier in the story they introduce something, but don’t address it immediately, in order to keep your attention, because you want to find out what happens next.

**Except not all movies or TV shows have closure. One of the greatest TV shows of all time, The Sopranos, has a famous ending that didn’t give it’s audience the closer they were hoping for.

 

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

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.

 

 



 

 

 

References

(1) Enron’s Open Secrets

(2) MRI findings of lumbar spine in people without back pain

(3) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation

(4) MRI findings in throwing shoulders: abnormalities in professional handball players

(5) Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period

(6) Metastability and emergent performance of dynamic interceptive actions

(7) The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain

(8) Different contexts, different pains, different experiences

(9) Nocebo hyperalgesia and the startle response

(10) Context as a drug: some consequences of placebo research for primary care

(11) Pain really is in the mind, but not in the way you think

(12) Reinstatement of pain-related brain activation during the recognition of neutral images previously paired with nociceptive stimuli

Rethink Pain: Posture

Xray bronze Vitruvian man isolated on white

I’d say that almost every practitioner who deals with people in pain would have heard a variation on the following a million and one times:

I have terrible posture.

The implication is that this “terrible” posture is:

  1. A problem, in and of itself.
  2. The cause of their pain.

Previously in this series I discussed moving towards a model of pain that focuses on the nervous system, rather than muscles and bones (and other tissues) and osteoarthritis.

This post is going to look at posture and it’s link, or lack thereof, to pain as well as strategies to improve your posture, including the role of osteopathy.

What is posture?

The position of the body with respect to the surrounding space. A posture is determined and maintained by coordination of the various muscles that move the limbs, by proprioception, and by the sense of balance. (1)

What influences posture?

A commonly held view is that posture is purely structural.

Unfortunately, while this would be great, as it would make things simple, it’s not accurate.

Posture, like pain, is an output of the nervous system, which is influenced by (in no particular order):

  • Skeletal structure
  • Psychological factors – mood, emotions etc
  • Physical activities
  • Postural reflexes

Does posture cause pain?

No.

There are people with all kinds of posture who have pain, and there are people with all kinds of posture who don’t have pain.

If posture caused pain, then all people with the same posture would experience pain, or all people with the same pain would exhibit the same posture.

When you understand pain is a protective output of the brain, you can extrapolate that when you have pain, and your posture is altered, these postural changes are protective.

By the same token, changes in posture that occur after treatment for pain, be it hands on or movement based (or anything else really), occur because your brain is no longer needing to protect the affected region, because the perception of threat or danger has decreased.

Do You Need To Improve Your Posture?

Whilst there is a very low correlation between posture and pain, there are at least a couple of reasons why you may want to improve your posture:

  • Improved movement efficiency
  • Improved aesthetics
  • To improve some musculoskeletal conditions (this is a separate issue, because it is specific to the individual and condition)

So unless these are a priority, then you have to ask yourself if you really want to (or need to) improve (or change) your posture.

If you do want to improve your posture, then there are things you can address:

  1. Your mood, emotions and mindset.
  2. You habitual activities and positions.
  3. Improving postural reflexes.

Sorry, but you can’t change your skeletal structure.

So now you know what to change, but how exactly do you do it?

Let me show you.

Change Your Mood, Change Your Posture, Change Your Mood

You can pretty much tell how someone is feeling by observing how they are holding themselves.

What is interesting, is that whilst mood affects posture, posture also affects mood. So if you are in a bad mood, simply changing your posture can change your mood.

Your mood is simply an emotion, a feeling, and according to the theories surround Rational Emotive Behaviour Therapy (REBT) “humans do not get emotionally disturbed by unfortunate circumstances, but by how they construct their views of these circumstances through their language, evaluative beliefs, meanings and philosophies about the world, themselves and others”. (2)

So really, to change your mood, you have to change your emotions by changing the language you use (to yourself and others), examine your beliefs and philosophies about the world. This will then have a flow on effect to your posture.

This is way beyond my scope of expertise, but if you find you are constantly experiencing negative mood and emotions, you could benefit from speaking with a psychologist trained in REBT or Cognitive Behavioural Therapy (CBT).

What You Do, You Become

Most of our day is made up of habitual tasks and activities. From the way you brush your teeth, to the way you pour yourself a glass of water, all the way through to your regular sitting positions and favourite activities (or lack thereof).

As our bodies crave efficiency, they will adapt to accommodate our habitual postures and positions. Some of this adaptation is structural (bone, muscle and ligament remodelling) and some is functional (loss of stability, range of motion, neural tension).

The way to change this is to increase your awareness of what you are doing throughout the day, and pay attention to how things feel while you are doing them. Then modify.

For example, if you always lean up against the left arm of the couch when watching TV, you are habitually shortening one side of your body and lengthening the other. If this was causing you problems, you could practice alternating sides of the couch, which might feel weird at first, demonstrating both the mental and physical adaptations that have taken place.

What You Really Came For – Reflexive Exercises

When we are babies, we have primitive reflexes. Part of our development sees these reflexes “going away”, however, in a way, they remain as our postural reflexes.

For an example, sit tall or stand, close your eyes and let your body sway. Once you hit a certain point, your righting reflex will kick in so you don’t fall over.

Sedentary lives devoid of rich tactile and movement based sensory stimuli can lead to diminished postural reflexes.

One way to “get these back” is to perform reflexive exercises.

These exercises aren’t like traditional exercises which focus on strength, power or endurance. These develop the qualities that underpin movement, which allow us to express and developed strength, power and endurance.

These are performed in a sequence, from most stable to least stable, and from least complex to most complex.

The positions we can use are:

    • Lying.
    • Quadruped (hands and knees).

  • Kneeling and 1/2 kneeling
  • Standing – bilateral stance, split stance and single leg stance

In terms of complexity, we can progress by:

    • Single joint movement

    • Multiple joint movement
    • Contra-lateral arm/leg movement
    • Contral-lateral arm/leg movement that crosses the midline of the body

 

Reflexive exercises are usually rhythmic and self-limiting (you can only perform them correctly, or not at all), which make them fantastic for not only improving posture specifically, but fundamental movement ability in general.*

Can Osteopathy Improve Posture?

Yes, but not in the way you probably think.

Most people assume that if they walk into an osteopath’s office, and come out after a series of treatments standing taller and feeling “lighter”, that the osteopath has somehow “straightened them up” as you would a stack of blocks.

In reality, osteopathy will affect the 3 aspects of posture described earlier:

  1. Interacting with a personable and affable practitioner can help improve your mood, emotions and mindset.
  2. An osteopath can help you identify your habitual activities and positions, as well as help ease some of the strains that these induce using manual techniques.
  3. Finally, an osteopath can help “re-ignite” your postural reflexes, both by using manual techniques to help improve body awareness and help address any issues that might be negatively affecting them, as well as through exercises as described above.

Conclusions

Posture is very poorly correlated with pain, which goes against much of the information you may have read online or heard from health practitioners.

Most of the time, things that are helpful for treating pain, like manual therapy, exercise and cognitive/emotional therapies will also have a positive effect on posture.

In most cases though, treating pain does not require a specific focus on posture, at least in the traditional sense.

 

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

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.

 

 



 

 

 

References

*I will post up some examples of reflexive exercises on my Instagram and Facebook pages over the next few weeks, so connect with me on those channels to make sure you don’t miss them.

(1) Harris, P., Nagy, S., Vardaxis, N., Mosby’s Dictionary of Medicine, Nursing and Health Professions

(2) Rational Emotive Behaviour Therapy

The Role Of Movement In The Treatment Of Pain

Movement

What is the role of movement in the treatment and management of pain?

We know physiotherapists have long time incorporated exercise(s) into their practice, but now osteopaths, chiropractors and other remedial therapists have started introducing exercise and movement as part of their treatment approach to pain.

Does this improve outcomes for people in pain?

As someone who has an exercise background, and a practice based in a gym (with a large number of patients who are active themselves), I’m a big proponent of empowering people with active management strategies to both help manage pain and improve health and fitness.

Large scale research projects have confirmed that an active, movement based approach is superior to a passive treatment approach for the management and treatment of many pain conditions.

Whilst the many benefits of exercise and movement are commonly known and widely promoted, the message can be misconstrued when context is not provided.

To understand the role of movement in the treatment of pain requires an understanding of pain.

Unfortunately, many people do not learn about pain when they seek treatment for pain, which leads to incorrect ideas and beliefs, that can make their pain worse.

The Dark Side of Exercise Therapy for Pain

In general, encouraging people to take an active role in their recovery from pain is a good thing.

Problems arise when exercise and movement is billed as being the treatment or “fix” for pain.

Unfortunately, nothing can “fix” pain, not manual therapy, not exercise, not medication, not surgery.

The reason being, pain is not a thing, pain is an experience, an active process. All of those methods create a change within your body and brain, so that your brain can resolve things.

So, as always, the context in which anything, including movement, is performed to help with pain is paramount.

What’s the big deal?

Many times, I have seen people who have been told to stand/walk/move in a certain way, because if they don’t “their pain will get worse”.

Others, rightly or wrongly, interpret their failure to improve as their fault, if they have been made to believe that exercise is what is needed to fix their pain, due to poor compliance. I often view poor compliance as not as the fault of the client, but of the therapist.

If someone can’t do something, then what has been given to them is too much for them at that point in time.

And yes, people still need to take responsibility for their actions, but the job of a health practitioner is to show the path in actionable steps, not unload a volume of information onto their patients (they could use google for that).

What’s In A Name?

Throughout this post, I have used “movement” and “exercise” interchangeably.

Whilst it is true that exercise is movement, it is also true that not all movement is exercise.

Exercise is purposeful physical exertion/activity performed to create a physical adaptation.

Movement is a preferred term, because it doesn’t have the connotations to exertion.

You shouldn’t need to exert yourself (physically) to overcome pain.

Mechanisms of Movement in the Treatment of Pain

We don’t actually know exactly what happens when pain resolves.

To clarify, we know that pain is an emergent property, that is, it has biological, psychological and social/environmental components, but it is not any one of these, nor does 1+1 = 2.

This means, that treatments for pain can be specific only up to a certain point.

Why does spinal surgery improve outcomes for some people, but not all? If pain were only physical, then surgery would always work, but we are not bodies, but people, and this needs to be considered in the treatment of pain.

That’s not to say we have no idea what helps pain, we do, generally, but what helps pain for any specific person at any specific time is going to vary.

One thing we do know, is that “all pain is neurogenic”, that is, all pain originates in the nervous system.

So for any intervention to help in the resolution of pain, it must have some effect on the nervous system.

Thankfully, we know that movement has a great effect on the nervous system.

Novel Input

Our brains crave novel sensory input. It is why we are generally attracted to “new and shiny”.

When we experience pain, it is an output of the brain, based on all the current sensory inputs from both the body and the brain itself (confusing? read this).

In theory, by providing novel sensory inputs, we can alter the outputs, including pain.

With movement, if we can “show” the brain a different way, then sometimes that is what is needed to “teach” it how to produce the desired output.

For example, let’s say you experienced low back pain that hurt when you bent forward.

If we change the context of your bending by having your feet in a split position and bending to the side, that might be enough of a different sensory input to change the output of pain.

Cortical Mapping

Our body is in our brain. We have a “map” of our body within our brain, such that when certain peripheral nerves are stimulated, a corresponding brain area is activated.

Conversely, stimulating that brain area with electrodes will cause a vague sensation in that region of the body.

When we have pain, we know that our “body map” is impaired. That is, we can’t clearly recognise our affected body parts like we can the unaffected ones.

Deliberate movement can help with cortical mapping, once again, by increasing the amount of information coming from an affected area.

Touch can help, but we seem to have a better response to active movement, likely because more brain areas are involved, resulting in a more pronounced stimulus.

Neural Mobilisation

This is little bit easier to understand for many people, because it is more of a direct mechanical effect.

Nerves are everywhere in our body. We have km’s of them.

They pass through “tunnels” of soft tissue all over the body.

They can get stuck or deformed.

When they are stuck of deformed, they will fire more rapidly and strongly.

Movement, can either directly, or indirectly mobilise the nervous system, freeing up your nerves to slide and glide freely, which is exactly what they want to do.

Descending Modulation

Our brains are pretty cool.

In addition to being able to recognise a bunch of pixels lit up on a screen into shapes (letters) as meaningful, they can produce a whole host of chemicals that can block pain at the level of the spine.

Aside: there are 3 levels where you can block pain. Peripheral, spinal and brain.

Movement can facilitate the production of pain relieveing chemicals, like endogenous opoidids. Much better than buying them at the pharmacy, because your brain is never going to get the dose wrong.

Improved Mood

There is a correlation between mood disorders like anxierty and depression and pain.

Regular and meaningful movement is correlated with improved moods, as is exercise.

You can probably see where I’m going with this.

So Movement is Medicine After All?

Definitely.

But just as taking the right medication, in the right dose for the right problem is paramount, using movement as an intervention for pain is the same.

More is not better if all you are doing is reinforcing the same behaviours that lead to or maintain your pain.

Think of it like this: there is the skill to perform a movement, and the capacity to perform it. If you have the skill, but limited capacity, you need to improve your capacity and vice versa.

Conclusions

Movement is important in treatment of mechanical pain.

Active movement is superior to passive movement in most cases.

The mechanisms of how movement affects pain are not specifically known, but there are plausible ideas, all of which must involve the nervous system.

These effects are what would be called “non-specific effects”. Whilst there are potentially “specific effects” occurring as well, we don’t know enough as yet to harness these more precisely.

In terms of pain: inputs + processing = output (pain).

To change pain, we are attempting to change our inputs, be it movement, education, cognitive behavioural therapy, manual therapy or something else.

Whatever it takes to get a change is what “works” for that person, in that moment.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

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.

 



 

 

References

Coming soon!

Stop Blaming People For Their Pain

Blame

This post is directed at the friends, families and health professionals of chronic pain sufferers: stop blaming people for their pain.

It is really common, whether overt or subtle, for people suffering from chronic pain to be blamed for their pain.

I would argue that this stems from a lack of visibility (you can’t see low back pain or migraines) and a lack of understanding, which I’m hoping to change.

Previously I have posted about both personal responsibility and pain as well as mindset and pain.

In these posts, I am not blaming people for being in pain.

Rather, I am urging people to take responsibility for their actions in the face of their pain, because that is the only way things will ever improve for them.

Chronic Pain Is Nobody’s “Fault”

Whilst you can definitely contribute to, or even cause your pain in certain circumstances, when it comes to chronic pain, it isn’t anyone’s fault that they have become “victims of their own nervous system”.

Let’s look at how most chronic pain arises:

  • Post surgical
  • Post physical trauma
  • Post major stressful event
  • Secondary to disease (e.g. rheumatoid arthritis, cancer, dengue fever etc.)

Now, we don’t know why certain people develop chronic pain whilst others don’t, despite having the same experience.

All we know is that each person has a unique psychological, emotional and physical makeup.

And that there is something about the event’s effect on that individual that sets their nervous system off on a path of persistent pain.

We can look at factors that are correlated with chronic pain, but again, very little is predictive.

In fact, in terms of pain epidemiology (which is the study of health and diseases across populations), it seems the two biggest correlates are out of anyone’s control:

  • Age
  • Gender (females suffer from more chronic pain than males)

So whilst we can definitely control how we act and react in the face of pain, we can’t control the onset or presence of chronic pain.

It’s Human To Judge

It is a human instinct to judge others, based on our own perceptions of the world and experiences with people.

Equally, it is important to recognise that all of us have limited experiences, and our judgements are made on limited (if any) factual information, and lots of assumptions.

We have evolved this way for survival reasons, but it can often get us into trouble when dealing with humans – we don’t know what’s going on in our own “unconscious mind”, let alone others’.

Considering this, it is easy for our brains to lump people into categories and assign blame – it makes our worldview “neater” and simpler, but it does so at the cost of making things simplistic, when often that is not the case.

Whilst you can’t (and shouldn’t) stop judging, you have to acknowledge the limitations that are inherent within our judgements and use your cognition (yes, you’ll have to think), before you act and speak.

What To Do Instead

You’re probably thinking, “gosh, this is hard, I’m going to feel like I’m walking on eggshells any time I have to talk to someone with pain”.

When someone is constantly complaining about their pain, they are expressing a need.

This need can be for attention, care, acknowledgement or reassurance.

Pain is rooted in fear; our brains have decided that there is danger (real or not), and that pain is the best motivator for change.

Unfortunately, chronic pain is the dark side of neuroplasticity (the ability of the brain to change), where the brain has become more efficient and skilled in the pain response, and so pain is not indicative of any damage within the body, but rather a heightened sensitivity to normal stimuli.

Instead of blaming someone with pain, try practicing empathy – that is, understanding what that person is experiencing, from their point of view.

It could be a loss of independence, a frustration at lost capabilities, a fear for the future, a combination of all three or something else entirely.

Conclusions

Pain is a normal part of the human experience.

We will all experience pain at different points in our life, and we hope that it is brief and not serious.

However, for many people, pain is not brief, but daily and ongoing, and a great disruption to their lives and their personality.

The vast majority of sufferers of pain have not done anything to “deserve it”, and so should not be blamed for their condition.

Instead, practicing empathy and acknowledging someone’s suffering is a better approach, without dwelling on pain and making it a focal point of your interaction.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

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.

 



 

References

(1) McMahon, S.B., et al, Wall and Melzack’s Textbook of Pain, Elsevier Saunders, Philadelphia, 2006

(2) Chronic pain epidemiology and its clinical relevance

(3) Preventing chronic pain following acute pain: risk factors, preventative strategies and their efficacy

(4) Risk factors associated with the onset of persistent pain