When my children were small they had a book that I had to read every night (as you do to small children). The book was called ‘That’s not my Pirate’, it was about a little girl looking for her lost Pirate, she looked at different Pirates that were nearly the same but not exactly. They might have different hair, different clothes or a different smile but they just were’t the right Pirate.
I was reminded of this book today when I was trying to explain how the body went through changes in a persistent pain state. I explained that there are changes not only in the tissues after an injury but also in the messages that go to the spinal cord and the brain, conveying information about stuff happening in the body. In chronic or persistent pain this gets a bit muddled, I likened it to Chinese whispers or predictive text. What you put in -or indeed think you put into the body- doesn’t always produce the response you expect. This may be more due to changes in the central nervous system and the brain rather than in the periphery.
Just like the Pirate in the book, pain can look different from one person to another, maybe someone in pain may shy away from activity, someone else will face it head on and ‘push through it’, others may look tired or adopt a protective posture to help alleviate symptoms. Pain can feel different, no two pains are identical and no-one experiences the same pain as the next person -fact! Finally pain can show itself in different ways, perhaps someones language will change, they may become withdrawn or low in mood as a result or it changes behaviour – you’re just not you.
Sometimes the person you see in the mirror looks like you but just isn’t you.
Pain is a complex thing, it relies on previous experience, feelings, context, understanding and origins of current knowledge. It isn’t linear and once it becomes persistent, there is no longer a direct link between cause and effect. This is why everyone experiences pain differently and there is no one pain or one pain centre in the brain, we all bring our individual quirks to the party.
This fact alone makes life tough when trying to explain pain. I use a lot of examples, stories and sharing of information with my patients and try to put a point in a number of different ways. I hope this helps people to pick the right analogy that fits with their life and understanding. Sometimes this works, sometimes not so much but I do my best.
As I finished explaining a little more about persistent pain changes on the body he became quite animated, saying he found it really interesting and that he would like to know more. He told me the brain was a fascinating thing and he totally believed that thoughts and feelings had significant impact on the physical self. He said he had read about this kind of stuff before.
Hooray I thought, after a weeks of trying to scratch the surface and show him a different way of looking at pain he’s got it, just enough to want to know more and then he said this…”but that’s not my pain!”
BSc (Hons) Physiotherapy, MSc
Physiotherapist, Lecturer noiUK