Recently, I attended two informative Professional Development seminars, focusing on Evidence Based Practice and pain science. The ‘Explain Pain’ seminar was hosted by three eminent physiotherapists; Lorimer Moseley, David Butler and Peter O’Sullivan who are heavily involved in pain neuroscience and research. Last week I attended a seminar by a Canadian physiotherapist and chiropractor Greg Lehman, who has a lot of experience in applying the Biopsychosocial model into the clinical practice. Both of these seminars introduced new concepts but also reinforced currently applied management strategies and clinical reasoning for dealing with any person who presents to the clinic in pain, both acute and chronic.
Modern pain science has changed our knowledge of pain and in turn our management of pain and injury. We now know pain is a complex and divergent experience, which is an output of the brain. Our current understanding of pain science has identified a number of shortcomings with the management of people in pain. A common misconception is that pain suggests there is always something physically wrong, when in fact pain and tissue damage are often poorly correlated and in an acute setting, pain is more of an alarm system to get us out of danger or further injury. You might be able to think back to a time when this has been the case for you- eg. stepping onto a piece of Lego, which can be very painful indeed but no real tissue damage has occurred. A story that clearly highlights the link between pain and injury is that of a tradesman who had a nail gunned into his foot. He went to emergency in excruciating pain, however, when they imaged his foot the nail had not even penetrated the skin- it had gone directly between two toes!!! A great demonstration of pain and how complex it can be.
If your pain has persisted for a period of time, the pain becomes even less about tissue damage and more about things in your life which can make you more sensitive. Your system can become over-reactive. It becomes easier for our pain to be triggered and many factors in our life can contribute to this. This theme was a key point at the seminar I attended last week and demonstrated that pain is multidimensional. There are many factors that impact our pain and increase our systems sensitivity including emotional, physical, mechanical and social stressors. A great analogy that Greg used on the weekend was thinking about these stressors as filling your cup and we can think of pain as the overflowing cup.
Your cup is filled by the BIO-PSYCHO-SOCIAL factors in your life and this includes all aspects of your life. Pain occurs when there is an inability to tolerate and adapt to those stressors. In terms of the cup, we need to prevent the it from overflowing to stay out of pain. This means we have a number of options available to help reduce our sensitivity and pain which gives us a range of strategies when devising a management plan. If you are experiencing persistent pain, have a think about what is in your cup… You and your therapist can work together to address these.
The above concepts and many more are addressed in the Osteohealth Pain Program. This program is run by Marnie and myself. If you think you would benefit from more information about pain management or attending the program we offer, please contact us at the clinic on 6021 2777.