What are you looking for when you visit a health professional? Most people would say they want to know why they hurt or what their diagnosis is. What if I told you that these things aren’t that important? Some people would stop listening or say I’m not credible and I’m not sure that I would blame you. I had a patient recently convey my point so clearly when she said “Pain is just information.” More important than a diagnosis is how you respond to your pain. But what makes you hurt? And what does that mean for you?
Pain science has come a long way even over the last few years. There are a variety of great minds in the field that have developed avenues of thought behind pain. Some individuals are of the mindset that pain is primarily in the brain (like what I did there?). Others believe pain only exists with a true peripheral injury. More important than choosing a side in the debate (or somewhere in between) is devising the best way to utilize pain science and research in patient care and treatment.
Long gone is the idea that if an MRI shows arthritis or the dreaded “slipped disc,” this is the cause of your pain. Instead, we now know that an MRI taken early in a course of treatment for acute low back pain not only fails to provide true answers but inspires fear, movement hesitancy, and often, increased pain in patients. This research is where the concept of “pain is in the brain” comes into play. Jason Silvernail, a well-respected colleague and researcher, stated in an interview that “…the level of pain people feel isn’t necessarily related to any damage to their body – because the perception, the judgement, comes from more than just the body tissues.” This concept emphasizes the impact of life experiences, associations, and social factors on the experience of pain so much that Lorimer Moseley has said “you don’t actually need a body part to have pain in it.” For me this instantly brings to mind the idea of someone with phantom limb pain but believers of this idea say this isn’t the only instance.
When it comes to patient treatment how do we apply this research? If all patient pain is coming solely from their brain should I quit my job as a physical therapist and refer my clients to a psychiatrist? I think, and hope, we would all agree that is a bit extreme. Even though past injuries, experiences, and mental associations play a part in a patient’s perception of pain, there is most likely a real physical origin or at least a physical contribution that requires intervention.
Research about pain and the impact of the brain alone on my patient’s pain perception gives physical therapists an insight into how we can treat in a more all-encompassing way. Don’t worry, I’m not trying to get my PhD in psychiatric medicine, I just want my patients to understand their pain better so they are able to process this information in a manner that is less experience or emotionally biased.
All of our patients at SPARK Physiotherapy receive considerable education regarding their pain. But first, and most importantly, we listen to our patients. Many have seen a myriad of health professionals and feel as if their concerns have been over-looked, their fears accentuated or emphasized, passed on to someone else, or blatantly ignored. This is the stage when a physical therapist might feel like a psychiatrist. Just by listening to our patients experience and concerns they often feel better physically and also more receptive to any educational spiel we might provide them.
Next, if patients have questions about imaging studies, we like to explain what information from it is relevant to the patient’s specific problem (which is typically very minimal). Other special tests and measures are explained as well as what their subjective evaluation would demonstrate for us. All of this allows our patients to view their complaints through our objective lenses, a perspective that has no fear or pain-enhancing emotion attached to it.
Here comes the big question – “Well why do I hurt then?” Our typical patient has been given obscure, text-book style answers to this question. They are desperately seeking an answer that is specific to their injury and complaints. Once in a while there is the patient that has been treated extensively; worked over with a fine toothed comb. Every tiny asymmetry, tight muscle, trigger point, hypomobile joint, weakness, and postural abnormality has been scrutinized and highlighted as THE key to their pain and dysfunction. At this point the therapist has to make a critical assessment as to what the patient needs. Based on the description of each you probably see the drastic difference in the specifics required by the first patient and a more comprehensive explanation given to the second. Whatever it is, the explanation should still be truthful, definite, and individualized.
A big piece of the physical therapy process is and always will be pain. When it comes to our patients, we like to emphasize the fact that pain provides us with information that fits into the puzzle. Patients are told to take note of their pain – the ways that it changes and stays the same. This information in conjunction with seeing how they move and specific tests and measures provides us with a mental check list of things we need to investigate and treat. Knowing this allows a lot of our patients to relax and pass the baton on to us.
Listen to these steps with your patients. Each step should be individualized to the patient but if you listen to them, provide them with answers, ease their worries, and gain their trust, soon their pain will feel more like “information” than the life-centered, disabling experience it had been before.
Dr. Kristen A Lattimore, PT, DPT, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist, and a Certified Myofascial Trigger Point Therapist. She has also had experience as an athlete and coach of the speed and jumping side of Track and Field. She is passionate about integrating her knowledge and experience with fast and powerful exercise into the practice of physical therapy. She also enjoys working with patients whose concerns and complaints have been overlooked and perpetually deferred to the next medial professional.
Kristen continues to challenge herself with varied exercise including interval running, weight lifting, yoga, and Pilates. She is passionate about making her patients their best selves and adding power and intensity back into physical therapy. She can be reached at firstname.lastname@example.org.