Did you know that Usain Bolt (the fastest man in the world) has massive scoliosis – a major curvature of the spine? Even though his body is far from symmetrical, he is able to compete at the highest level we’ve ever seen in a sprinter. The shape of his spine does not predict his pain experience. This is just the tip of the iceberg of the evidence we now have that the structures in our body cannot predict pain.
Pain is far more complex, and this is a good thing! I invite you to embrace the complexity of pain as something that can actually be freeing, rather than being daunting. It means there are lots of opportunities to bring in tools that can change our pain experience. The complexity of pain can actually lead the way to a wide range of solutions.
In the history of Western thought, there has always been this notion that pain is complex. Aristotle said that “pain is a passion of the soul.” It’s both physical, emotional and soul.
So, although there are many ways to understand and measure pain, we are now clearer than ever that if someone says they’re in pain, they are in pain. That’s the only way we can actually honour someone’s internal experience with pain.
Yes can use scales, and questionnaires, but there is clear evidence now that we cannot rely on scans or imaging to accurately measure pain.
Former Chair of the International Association for the Study of Pain, Fernando Ceveró says:
“It’s very hard to measure pain. Pain is a complex experience that can only be measured by verbal report of patients”.
(If you’re interested in exploring more really great evidence from within the medical community about pain, you may like to listen to this Body College podcast episode “Pain is Really Strange”, where I celebrate the complexity of pain, and align myself with Aristotle by saying that pain is not a pure sensation but complex perception; it’s always about emotion, it’s always about story, it’s always about a whole, complex humans, inside a complex world. You can listen here: Body College Podcast “Pain is Really Strange”)
So where do we go from here? With 1 in 5 of us experiencing persistent pain (according to some studies I explore in the podcast) and growing opioid crises in many countries, how can we approach pain in a novel, useful way, to actually help people to change their experience?
Here are five suggestions (listen to the podcast to hear many more).
ONE: Explore how you describe pain to yourself
How you describe the pain to yourself is really important. Find metaphors that speak of change and movement, instead of descriptors that imply fixity and damage. The founders of ‘Explain Pain’ have developed a new model of pain education:
Pain improves when Safety in Me (SIMs) exceed ‘Danger In Me’ (DIMs.)
Here are some examples of ‘Danger In Me’ messages and metaphors:
• My MRI shows a slipped disc.’
• ‘My therapist told me I have one leg shorter than the other.’
• ‘Something is broken or stuck.’
• ‘My father had pain at my age.’
• ‘Old people always get pain.’
• ‘I have arthritis.’
• ‘I have no time to rest.’
Some ‘Safety In Me’ messages and metaphors include:
• ‘There is a poor relationship between MRI findings and pain.’
• ‘Discs can never slip.’
• ‘I have strong repair systems and life, like water, will flow somehow.’
• ‘People with one leg can have no back pain.’
• ‘I am not my father. I heard a story about a 90 year old running a marathon.’
• ‘I will try moving through the pain, but slowly, to build resilience.’
• ‘Most people do not have smooth joints, bumps on x-rays are like smile lines and wrinkles.’
• ‘More sleep and less stress will make me less sensitive.’
Try It Now:
How do you describe your pain to yourself? Let yourself have an image of the painful area, for a short period imagine the exact opposite of what you are feeling. Try and describe the pain differently to yourself, be creative and explore metaphors that imply change.
TWO: Learn to feel the slow background tone of the body
Changing the representation of the body in the brain is probably the mechanism underlying all manual treatments. When you rub, stretch, press, stroke, adjust or touch the body, local tissue dynamics change primarily because the control via the central nervous system changes.
Try to frame your interventions within a control paradigm not an alignment paradigm. Switching off danger signals in the alarm systems (control) is the biggest regulator of tissue tension and joint position (alignment).
Interoception, the fancy name for the slow background tone of the body, is often missing for people in pain. Distorted body image is being linked more and more with chronic pain. Working to build a nuanced, detailed sense of the body is inherently anti-pain.
We know from trauma research that dissociation is the key problem preventing us from feeling our bodies. So, when working with pain appreciate that life and death defence strategies are often in play in the old brain, making it scary, anxiety provoking and very intense. Go slowly to help create a sense of safety inside you. Make it a game to learn to feel the Weight, Outline, Skin and Inside (WOSI) of your body.
Try It Now:
Close your eyes, how does your left side feel compared to your right? How big or small do your feet feel? Take your time and explore the differences and any distortions. If your feet feel different or distant there is work to do.
THREE: Tell yourself that chronic pain is an alarm system gone wrong
If someone stands on your toe, are they hurting your toe, or are they hurting you? The old model was that a fixed pressure on the toe would generate a fixed amount of pain, pain was an input to the brain. That model is wrong. The danger signals from the toe are assessed according to all the other priorities in the central nervous system.
Humans are irreducibly complex. Your pain experience can depend on your history, culture, family, stress levels, previous experience of pain and even your faith. Pain is an output from the central nervous system, not an input. What if the person who stepped on your toe was an incredibly attractive dance partner? What if you had just had a bunion operation on your big toe? The two pain events would be very different, you might even like the first one as it helped bring you closer!
Pain is in you and in your world, not in your brain or in your toe. In chronic pain the reflex, habit and memory of creating an alarm signal gets out of sync with the current state of the tissues.
Try It Now: Repeat after me:
I will not say pain is due to misalignment in joints, slipped discs or getting old ever again.
I will not say pain is due to misalignment in joints, slipped discs or getting old ever again.
I will not say pain is due to misalignment in joints, slipped discs or getting old ever again.
FOUR: Keep moving, keep moving, keep moving
Brains love movement. Movement feeds the brain lots of good news. Variety, creativity and precision when moving all help to overcome pain. Ordinary movements of standing, sitting, lying, getting up, walking, lifting, running for the bus and carrying shopping will not damage or injure you.
Fear of movement is a bigger problem than actually moving. Even for elite athletes, with lots of twisting, straining and impacts, it is unlucky to get injured. It needs a lot of force, not present in ordinary movements, to cause physical damage to joints and tissues.
Movement helps to lubricate joints, ‘Motion is lotion’. The more you move, the healthier your joints become and the healthier and happier you will become. Strength is consistently a predictor of living to a healthy old age. Sit less, walk more, try new activities.
Try It Now:
Try the ‘sitting-rising test’: Can you get up, and down, from sitting on the floor, crossed-legged, without help? If not keep practicing!
FIVE: Understand growth is bumpy
The road to recovery is not always a smooth upwards curve. Overcoming pain requires cycles of challenge and recovery. The challenges often involve moving and feeling in new and creative ways.
Intense work should be followed by equally intense downtime (e.g. getting enough sleep). If you overdo the work you may crash, get disheartened and give up. So be careful to build up slowly. ‘Graded exposure’ is the useful term that pain and sports performance researchers use.
Even with recovery time, expect learning to move again to hurt a little bit. It’s important to remember that hurt does not equal harm. The intense sensations associated with change are most likely to be the alarm systems in the nervous system recalibrating as tissues rebuild.
Try It Now:
Challenge yourself to do a bit more exercise and a bit more rest this week.
Next steps:
1 If you’re curious to study this topic further, and would appreciate a deeper exploration of the evidence-based studies and medical research that ground these unexpected approaches – please listen to this episode of the Body College Podcast “Pain is Really Strange”.
2 I teach two-year courses in non-doing, relational touch to change our experience of pain – you can find out more at an intro day below.
Upcoming Trainings:
Tension and Trauma Releasing Exercises (TRE®):
TRE intro days:
London: 11 Mar, 20 May, 15 Jul, 23 Sep, 18 Nov
New TRE 1 year Training
London: Starts June 2024
Biodynamic Craniosacral Therapy (BCST):
The Art of Touch 2 Year Training: London – starts Oct 2024
The Art of Touch 2 Year Training: Galway – starts Mar 2024
The Art of Touch 2 Year Training: Waterford, Ireland – starts Oct 2024
Art of Touch Craniosacral intro evening:
London: 7 Mar, 9 May, 11 Jul, 19 Sep
Galway: 1 Feb, 11 Apr
