The idea of pain only being a result of bodily tissue damage or injury is outdated. Pain and tissue damage can be independent of each other, particularly in chronic pain experiences. Chronic pain is pain that has lasted longer than 6 months. During chronicity a pain experience can be associated with a life theme of meaning. Lee can use Metaphor Informed Somatic Therapy (MIST) as a way of helping people move away from outdated ideas about their discomfort and pain.
The biopsychosocial pain model takes into account life experiences. It is in these experiences that our thoughts of individual meaning are consistent enough to graduate into an emotional (automatic) response that can reoccur without our conscious mind being aware of the thematic meaning that is at play. We then layer the meaning with other meanings making our pain experience seem distinctly separate to our life experiences concluding something has happened, eg I have damage in my body and my pain is due to that damage and or defect that I must find in order to overcome my pain. Pain however, is defined as a sensory emotional experience (1).
A body in health moves with ease. A body in poor health doesn’t have ‘elbow room to move’. Thus when feeling mechanically stiff in the body we have dis-ease (2).
The social interactions in our life, the concepts we hold, the narratives we grow up into, the workplace that contains us, and the friends, family and colleagues who influence us, can affect our sensory emotional experiences of life. Pain as a word comes from Latin and Greek meaning penalty and later from French to include suffering. Much more recently pain experiences have begun to be explained in terms of psychology and morality. Severe / chronic back pain does not have to be caused by degeneration, damage or a disc issue. Disc prolapses and bony degeneration occur commonly (3) in those over 20, unrelated to a pain experience.
The Four Aspects of pain
Shown above is a simplified view of how one can describe their pain (being able to describe pain is not essential for someone to be in pain). Elsewhere in nursing, for example, pain is given 7 dimensions, however trying to group experiences into particular cubies is problematic so Lee has kindly focussed on how to describe the feeling of pain(s). Because it is in the description of a painful experience that a therapeutic relationship can begin.
The 4 aspects of pain above can help one to notice and then describe to Lee their improvement. Pain improvements are not always ‘light switch’ or ‘linear’ experiences. During the first 3 weeks of a treatment plan the improvement in your muscles and joints may only be noticed in one of the 4 aspects above. Without getting into too much detail, Lee sees the change process of decreasing discomfort and pain(s) as a ‘Both And’ transition (see forgetting my old PIN number).
When your symptoms are slow to respond to Chiropractic Care, the pain you feel may be a compensatory pain, which is why the first three weeks of Care are the most important in which to trust in and follow Lee’s advice.
For a few unlucky people pain can be amplified at the spinal cord causing central sensitisation. Typically here prognosis is not as good and the timeline to begin recovery will be months and not weeks. Lee will talk to you in your physical or online sessions if he considers central sensitisation as important in your MSK pain experience.
Pain generated in the brain from social context, interactions and circumstances is found in the same part of the brain that registers physical injury. Whether pain starts in the brain as you being given the ‘silent treatment’ or in the body as a slip or a fall becomes (almost) ‘chicken and egg’. Medical science tells us the part of the brain that generates pain from social and emotional context is called the Anterior Cingulate Cortex (ACC).
The ACC can be ‘cut out’ in a brain surgery procedure called a Cingulotomy after which people still report having pain but are not bothered by it. Because people are not bothered by their pain then we know pain and suffering are truly distinct. Therefore we are all equipped socially to help each other with individual suffering (eg my friend helped me feel better). Hence, in Lee’s professional role of helping people with muscle discomfort and joint pains, he is friendly. Being friendly to professionally support you feeling better is different to being friends who share in life experiences.
- International Association for the Study of Pain (2016); Terminology; Pain
- Merriam-Webster Dictionary. The History of Disease: Lacking in ease
- Brinjikji P.H. et al (2014) Systematic Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Am J Neuroradiol 10.3174/ajnr.A4173