I work with people in pain. As much as I hope to establish rapport and a sense of partnership in our time together, none of these folks are hanging out with me because I’m a joy to spend time with (I am!) or because rehabilitation is an excellent opportunity to learn about oneself (it is!) They enter into physical/yoga therapy because
pain is a problem, and they’d like it to go away.
I’ve noticed that many people in pain treat their pain as an enemy— something to fight with a vengeance or to beat into submission. But given the shift in our understanding of pain (see my blog Pain Part 1: Enter the Matrix for a debriefing on this topic,) it seems to me that it might be useful to befriend pain, rather than vilify it.
If you are wondering why on earth I’d ask you to consider making friends with something that plagues you, I ask you to consider the science. After all, the purpose of pain isn’t to make you miserable.
It simply exists to protect you.
Pain tells us, “Don’t touch that!” when we grab a hot pan, in an attempt to minimize the tissue damage of a burn.
Of course, a friend who only warns you of danger after you’ve injured yourself isn’t nearly as helpful one who warns you before you hurt yourself, so with each injury (or potential threat to your safety) your nervous system adapts to try to anticipate what might cause damage in the future so it can warn you in advance.
In this regard, pain can become a hypervigilant friend—someone who tries to protect you from potential dangers even when you are perfectly safe. My sister recently reminded me of the times we spent growing up wearing life vests while playing on the swingset. The swingset was much closer to the house than a nearby body of water, but our mother felt she was more diligently protecting us from the possibility of drowning by having us swing in coast-guard approved floatation devices.
Like an overly-protective loved one, pain can sometimes go overboard when it comes to keeping us safe. When the nervous system is hypervigilant, it doesn’t warn you with a kind word of caution.
It makes sure you listen by creating a bothersome pain experience, even in the absence of danger/damage.
The nervous system has a remarkable ability to adapt, and it will create physiological changes that amplify your pain, in order to get your attention and keep you safe from potential danger.
How would you know if your pain system has adapted to become hypervigilant? You may be told you have no tissue damage, or more likely, you might have some physical issues (like tight hamstrings, poor posture, etc.) or age-related changes that are deemed “normal,” but these biomechanical issues don’t quite explain the intensity, frequency, or duration of your pain. In such cases, it is likely that your nervous system has adapted to up-regulate your pain, making it seem more like a nasty bully than a helpful friend.
What’s worse, the more you get angry, kick and scream at the bully, or even become anxious or worried about the situation, the more likely your nervous system is to perceive danger (not just physical danger, but the larger context sometimes referred to as the biopsychosocial model.) And by now, you’ve probably guessed that seeing your pain as “the enemy,” and the associated swamp of anger, anxiety and dis-ease you are swimming in, can indeed make your pain worse.
So how do we get our pain processing to re-calibrate and behave more like a helpful friend?
Well, it turns out that educating yourself about pain physiology is a good step toward improving your relationship with pain. Studies have found that learning about pain (aka. therapeutic neuroscience education) reduces pain and disability, even in the absence of other treatments. Just as the nervous system adapts to up-regulate, it can very quickly adapt by down-regulating when the higher processing centers (like the ones that are reading this now) provide input that says,
“it’s ok, this bothersome experience is just your friend, Pain, trying to protect you.”
If you can recall a time when you were uneducated about a particular bodily symptom, perhaps this will seem obvious. When we don’t know why something hurts, it is human nature to worry about what could possibly be wrong (this well-established negativity bias is, once again, designed to help keep you safe.) In its efforts to protect you, your brain will conjure up images of the worst possible scenarios to motivate you to take action. Of course, worry and anxiety increase your brain’s perception of danger, which can, in turn, increase your pain levels. When an appropriate action is taken (i.e. you get the medical attention you need and come up with a reasonable plan for treatment) you can breathe easier and you might even notice that you are even starting to feel better.
Of course, for many, pain education is just one step on the journey with pain. To get you started, here are some free resources for pain education, generously shared by some of the leading experts in pain science:
- Understanding Pain: What to do about it in less than 5 minutes
- Joe Brence: 9 things you should know about pain
- Lorimer Moseley: TEDx Why Things Hurt
- Lorimer Moseley: Tame the Beast
- Neil Pearson: Life is Now Pain Care
- Neil Pearson: Overcome Pain 1, Overcome Pain 2
- Greg Lehman: Free Download for Pain Science e-book
While you certainly don’t have to review all these sources, I’ve listed them according to depth (starting with a 5-minute video, ending with a complete e-book for patients and providers) in the hopes that you find a resource that meets your need.
Remember, the goal isn’t to eliminate pain—we just want it to be more helpful in its efforts to protect us. This can be a long and tedious journey, and many will benefit from guidance along the way, so please seek out a team that is up-to-date on pain science and experienced in its application with complex, persistent pain.
Because pain can be quite complex and tedious, I’ll be covering even more resources in my upcoming blog, Pain Part 3: Healing your Body-Mind. Until then, you might try this simple exercise the next time you experience pain:
“Hi there, Pain! Good to see you again. I know you’re here to warn me of danger, and I want you to know, I hear you. I see you. I appreciate how hard you are working to keep me safe. I’m so glad that you have brought my attention to this matter and I promise you, our executive centers in the pre-frontal cortex are already figuring out what needs to be done about it.”
Keep in mind, Pain is smart, and you will actually need to follow through with appropriate steps to convince your nervous system you are safe so it begins to down-regulate the pain experience. In case you were hoping to get a tangible, physical exercise from this PT/yogi, try this: take some deep slow breaths and move in any way that feels good, or doesn’t increase your current level of pain. More guidance on this to come…
I genuinely hope that these resources help you walk through life with pain as your protector, one that behaves as a loving friend more often than not.
Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92(12):2041–56.[PubMed]
Moseley GL, Hodges PW, Nicholas MK. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20:324–30. [PubMed]
Wojciechoski M. Keeping pain out of the red zone. PT in Motion. 2017; 24-31. Print.