What’s all this pain about?

Hello-My-Name-is-Pain

Pain is the primary presenting complaint given to an osteopath. It is an economic burden and can dictate how patients live their lives. So naturally, it is the best place to begin joining the 50,000 people starting up a blog every day

Recently, I had a referral from our massage therapist for a work cover patient that wasn’t happy with how he was progressing with his current treatment and management plan. He had lower back pain resulting from excessive lifting at work. He was the sole income provider for his family and had tried therapy for over 3 months with little to no improvement.

Firstly I listened to his story. Really listened, without interrupting him. His frustration was evident as he explained that not even an MRI scan could detect any abnormalities. He went on to say he hated his job, missed playing sport and also doing the things he used to do before he was married with kids and a mortgage. He was also fed up with the side-effects caused by medication cocktails used to help manage his pain.

We began to talk about his back pain. I told him, “all pain is a product of the brain which is designed to protect us. It brings to our attention any actual or potential threats to tissue health so that we may act upon it” (1) The information coming from the periphery is not pain, it is a warning. It’s the brain that decides whether or not it will hurt”.

“Great, so you think it’s all in my head,” he asked me, a tone filled with a mixture of sarcasm and frustration

“Yes and No. I have no doubt you are experiencing pain, you wouldn’t be here otherwise. But when the pain has been around for a long time, sometimes the information coming from our back, doesn’t accurately represent the condition of the tissues. Pain is reliant upon context, the brain must put together the warning messages it’s receiving, and everything else related to the injury. How you think and feel about your pain, what you’ve heard, and your previous experiences all affect the answer to the question is this dangerous or not?”

At this point I pause for dramatic effect, letting the information seep in. The patient stared at me, with a furrowed brow. He hasn’t heard this before.

So I continue, “Do you think your brain is worried about how you’re going to support your family with a bad back? How being at work makes you unhappy? How you’re going to pay off your mortgage without an income? What about being unable to adequately explain your pain despite the most sophisticated medical imaging techniques?”

There was no doubt that this man’s body was responding to all of these stimuli. “No wonder your nervous system has now become sensitive to anything that may affect your back. Without it, you would be unable to provide for your family”.

I did some treatment with him and gave him advice on diet, exercise and other potential lifestyle changes. We mutually agreed on the “this is what you can do to help yourself” approach, rather than previous generic instructions that preached “Don’t do this and don’t do that!”

At the conclusion of the consult, he shook my hand vigorously, understanding now spread across his features, accompanying a somewhat goofy smile. It was a light bulb moment for him. He got it. He felt empowered by an understanding of his pain, and now he had the tools to more appropriately manage it.

A patient armed with knowledge and understanding can be more actively involved in their own management. A patient who helps themselves is a patient with better prognostic outcomes.

  1. Butler, D. & Moseley, L. (2013). Explain Pain (2nd Ed.). Adelaide, South Australia: Noigroup Publications