The body is not out of order, the brain is not damaged, your body is doing exactly what it thinks it needs to do to protect you.
It amazes me every day the stories I hear about what clients have been told, or understand about pain. People have been told things like “chronic pain is like having brain damage” or “if I dissected you right now, we wouldn’t find your pain”. I think I understand what people are trying to get at with statements like this but these individuals are not then checking with their patients what they themselves have understood by such words. Consequently if we aren’t checking what the person in front of us understands after receiving news like ‘you have brain damage’, they also are failing to acknowledge the long term effect of their words on that individual.
You see, a clinician may well tell someone not to worry because it’s only a bit of degeneration in the spine and neck, or that chronic pain affects brain function, a bit like having brain damage, but the likelihood is, that the client will be a bit freaked out by this news. I am pretty sure, the bombshell of having brain damage will almost never leave their thoughts and may have a significant impact on how they then go out and live their life.
Clinicians are well meaning people, eager to do the best for those who present to them with pain, we often pat ourselves on the back and think that “I did a good job there”, I would understand my problem of pain more now. But patients seeking help for pain are not clinicians, they do not have the necessary background to put into context that pain is influenced greatly by multiple factors, or that pain itself is produced in the brain but contributed to by many different things other than injury sustained to the body.
I think there is also an assumption that individuals in pain may not either understand the science, or indeed they may not actually want to know why they are in pain. Maybe health professionals think patients are happy popping pills and sitting at home. Well I absolutely know that is not the case and I think it’s time we gave credit to the everyday person in Society that they are more than capable of understanding pain and doing something about it. In fact, most people are delighted to know that they can change, they can get fitter, stronger and change the way they feel about pain. It’s not rocket science, it’s simply giving people the information they need to make an informed decision about how to move forward.
In the group education sessions I run, there are attendees from mid 20’s to late 70’s, all of whom are not idiots and have more than enough intelligence to understand the information I give them about pain. We discuss it, sleep on it and come back with different questions to consider the following week. When people understand something, they are less fearful of it, they can take ownership and begin to become objective about what and how they feel. Education is indeed and analgesic.
It’s all about understanding and perspective, giving people the right information, and enough of that information for them to be able to understand. We can’t expect people not to be scared witless by being told they have brain damage, but put in the right context of explaining how the brain works to protect in a pain experience, how multiple different output system meet and work together and how the brain is plastic and can change, may just put a different and less fearful spin on things. Degeneration, I was told recently, sounds like “I’m about to die”. Again, for a medically trained person it’s pretty standard language but for Barbara it’s pretty bloody scary. By the time clients seek help, this word has been playing on their mind for a number of weeks or even longer, enter massive amounts of stress and worry to bombard the system!
We all know that you can’t “just remove the bit that causes pain?” (which is probably what was meant by the comment “if I dissected you right now I wouldn’t find your pain”). Pain is much more complex, but it would be lovely to be able to say, ‘yes, go on then, lie down and I’ll sort that for you know’.
The thing is, we can go a long way to removing the ‘pain bit’, but by confronting all the other contributing factors in life, understanding and good education, not by dissection.
BSc (Hons) Physiotherapy, MSc Neuromusculoskeletal Healthcare, Lecturer Noi UK