How Do You Think About Pain?
I don’t know about you, but I was raised to think pain was the direct cause of tissue damage or disease. Skinned knees hurt, right? So why is it that skinned knees can stop hurting moments after the band-aid is applied, or mom kisses it better? It’s still skinned, maybe even bleeding a little, and has barely started to heal.
As an adult that damage/pain association continues. The doctor tells you the results of the x-ray or MRI like degeneration in the spine, or arthritis, or some other bone or joint issue. Sometimes there are incidental findings in places you don’t have pain and you figure it’s only a matter of time. Sometimes there’s nothing to be found.
Messages about pain can be mixed, and often contradictory. Sometimes the doctor will say that the findings don’t mean much for the pain. Or that it’s bad, but not bad enough for an operation. Manual and physical therapists might tell you that something is weak, or not “firing” properly. If you do the right exercises then you’ll get better. Or they say words like misaligned and out of place and tell you not to move certain ways. Maybe you get the dubious honour of having the tightest muscles they’ve ever felt.
Soon, each time there is an old or new pain it means things must be getting worse. It’s a slow, crumbling decline from this point on. You’re too afraid to move in case a joint goes out of place or you’re doing it wrong. And what else are you expected to think?
Rethinking Pain is Not Straight Forward
The science of pain has given us new insight into how and why we hurt. The science isn’t precise. It can’t tell us exactly how much input a disc degeneration might actually have and what that might contribute to the experience. But it has shown us that every pain experience is the result of multiple factors. Some nociceptive signals (noxious chemical, thermal, mechanical information) might be coming from your back or joint, but they are only one piece of information that comes your way. What about all the other impacts, like how you feel, what you’ve been doing that day or week, how much stress you are under, how little sleep you are getting, and what you believe is happening?
One way of thinking about pain is that it’s part of our protection systems. Experiencing pain will stop or change the way you move, but having pain doesn’t tell you exactly why you’re having it.
Shadows in The Alley Way
Say you’re walking down a city street. Same street you’ve walked down every day going to and from work for a few years now. You know it well. The seasons are changing again. It’s darker and the streetlamps are on. Up ahead, where two buildings meet and form an alley way, is also where the light from one lamp fades, and where the light from the next lamp starts. It’s a little grainier there, but it’s not like you haven’t passed this alley way hundreds of times. You walk on.
As you’re nearing the alleyway you look at the entrance and in an instant, where there was darkness there is now more light. A shadow in the alley way.
You stop and wait. Watching. Maybe you’ll see it again, figure out what caused the shadow to move. But there’s no change in the light, and you wait just a moment longer.
This is where the negotiation with yourself starts. Do you keep walking, secure in the knowledge that you’ve passed this alley hundreds of times and nothing has happened? Wasn’t there an incident not far from here just recently? Maybe it was just a trick of the light, but you check your bag for something weapon-like anyway. What if you pass by and something bad happens?
A Tad Overprotective?
Statistically the chances are great that nothing is there to harm you, and it’s just a trick of the light.
You cross the road and avoid the alley anyway, just in case. It’s an overly protective move and you feel a bit silly for doing it, but it costs very little to go a bit out of the way.
The next day you walk down the street in the daytime, and when you come to the alley you look down it, just to be sure. There’s nothing there, but from now on you check, every time, just to be certain. Sometimes, for no reason, you just walk on the other side of the street.
A pain experience can be sort of the same. In the majority of cases there isn’t anything grievously wrong. But, once the nervous system has processed all the information it’s not just discarded. Now you have a vague “heads-up” message that keeps you on your toes.
Can Pain Be Understood?
That makes it pretty difficult to really “understand” pain. It also makes it difficult to treat pain. Treatment for people with persistent pain has been less than successful and one in five Canadians will experience persistent non-cancer musculoskeletal pain. The current opioid crisis is an illustration of where we’ve failed. These drugs were developed to be of benefit for people with intractable pain, but were put into widespread use because options seemed so limited.
Up until recently very few in the medical and therapeutic fields were any good at understanding pain. Thanks to the persistence of those few, that understanding is rapidly changing.There is an evolution in manual/physical therapies and medicine in Canada and around the world to understand, better manage and to some degree explain pain.
Pain Can Be Changed
MOVE Pain Care is proud to be part of that evolution, though some call it a revolution. The hope is that by providing you with information to rethink pain, how it’s treated and how it is managed, that can help change how it’s experienced.
Find more information about pain on our Pain Resources page.