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Insight 1

It is essential to fully grasp the fact that pain is a product of the brain - not of the body part in which the pain is perceived. Here's why ... let's use your thumb as the example.

  • A stimulus is received at your thumb
  • That stimulus is turned into an electro-chemical event that travels up a bundle of neurons as an action potential
  • That action potential reaches the spinal cord and is modified
  • The message then converges with other information as it travels up the spinal cord to reach the brain stem. It's important to understand that this message is now a combination of the original stimulus plus information coming in from other areas of the body
  • When all that information reaches the brain stem it is again modified and mixed and then sent on to the thalamus
  • In the thalamus that information is split and dispersed into vast areas of the brain ... each one modifying the original message
  • All of this has happened without your conscious knowledge
  • Of major importance are the memory centers of your brain. These help you recall what a 'thumb' is and what it means to you.
  • Of course, your somatosensory cortex gets the message too.
  • If, and it's a big IF, your brain decides that there is sufficient risk or threat, then it will unleash a pain experience for you to consciously perceive.
  • This conscious perception is the final result of the original stimulus, modified, mixed, diluted and associated with memory and emotion.
  • Before you are consciously aware of it, we call this information 'nociception'. Only when you become consciously aware of it does it get called 'pain'.

Gives a new meaning to the phrase, "My thumb hurts", doesn't it? Does your thumb 'really' hurt now that you know pain is an output from your brain, and not your thumb?

Insight 2

​The stimulus, or message, that we receive in the brain from our thumb is not linear or constant. I liken it to an alarm system that has a sensitivity switch.

​Imagine for a moment that your car keeps getting broken into, and by the time the alarm has gone off, the burglar has escaped. So, you change the settings of your alarm system so that even if the neighbours cat takes a look at your car, the alarm will go off.

​Now, this idea sounded like a good idea at the time ... turn up the sensitivity of the alarm to detect burglars before they get anywhere near the car. The problem is that now your car alarm is going off all day and night ... because it's being set off by the smallest of things.

​And so this is how our nerves work. They don't just report the basic facts. They can turn their sensitivity up so that even minor, non-injurious messages will trigger the alarm.​ Or, vice versa, they can turn down their sensitivity.

IMPORTANT: The same stimulus, or message, could be reported differently by the same person ... depending on the state of their nervous system.

The ramifications of these first two 'insights' are massive.

Insight 3

Even the way your brain creates the pain experience for you will vary based on many factors. For example, if you are stressed or worried about the pain, then it will feel worse. Or, if you are too busy with another urgent matter you might not even notice the pain​.

What this means is that if you can modify the person's experience of the pain, then you can indirectly increase or decrease their perception of it, just based on what you say and how you behave.​

Insight 4

Pain is not a problem, pain is a warning. It's quite a lot like thirst, or hunger. Most people aren't scared of thirst or hunger ... if either of those things happen, they people understand what to do. The either drink or eat something.

When it comes to pain, however, people can get scared of the message ... of the warning itself. And then, instead of listening to it or seeking to understand it, they just want to get 'rid' of it without understanding it. This is what can happen when people seek habitual pain relief with medication, or even treatment.

So, this insight is all about understanding that pain is on our side and that rather than seeing it as the 'enemy to be destroyed' we will do better if we see it as a friend we need to understand.​

By understanding that your brain produces pain as an early warning signal when sufficient threat is felt, and that the input (signal) and the output (pain experience) can be vastly modified based on many factors ... you stop looking at pain as the 'problem' and start looking at it as the messenger.

What is this person doing with their body that is causing this early warning signal to keep going off?​

Insight 5

When patients consult practitioners about a pain problem, it's because they are worried or concerned about it. ​So, the practitioner is dealing with the early warning signal AND the anxiety the patient has about the early warning signal.

This provides the smart practitioner with opportunity, because they know that they can help improve the situation by reducing anxiety. They can do this by remaining calm themselves. By being self-assured. By listening to the patient and validating what they are experiencing.

​PAIN + ANXIETY = OPPORTUNITY

The best way to achieve this is with the patient history. ​Not only does this provide an opportunity for the patient to express themselves, but it provides the opportunity for the practitioner to ask key questions and listen intently to the answers. This is when they will most likely discover what the person is doing to trigger this pain signal.

So, rather than moving straight into treatment to reduce or silence the message ... this insight is all about listening to the pain message to better understand it. Again, what is this person doing to trigger this message? How are they using their body to trigger this message?

So, rather than moving straight into treatment to reduce or silence the message ... this insight is all about listening to the pain message to better understand it. Again, what is this person doing to trigger this message? How are they using their body to trigger this message?

Hone up on your history taking skills. And just when you think you've dug deep enough, dig a little more ... even if it means delaying treatment in the first consultation.

Insight 6

Whatever it is that you find out through the history, take this with you into your physical examination. The amazing thing about the standard and sophisticated physical examination tests for pain are just how unreliable most of them are.

​So, what should a practitioner do?

Insight 6 is all about having the patient show you how they really move in the wild. It's not about how they move awkwardly from an anatomic position that they rarely ever use in real life. Physical examination is about functional assessment. Get the person to show you exactly what they do in their life that either brings on the pain or relieves it.

If you stop at just doing the standard tests you will miss much valuable information.

For example, if a surfer complains of ankle pain that they get when surfing ... and all you do is perform standard orthopedic tests on their ankle and come up with nothing ... then that doesn't really mean anything. You need to understand what happens to them when they're surfing, not when they're standing in a treatment room following standard movements.

Have them show you ... at the very least get them to try and replicate the moves they make when they surf.

Note that there is no such thing as the 'surfers test' for ankle pain ... but you wont be held back by that, because you understand that pain is an early warning signal ... trying to get a message across.​

Make it real. Use the physical examination as a functional assessment, not just a standard physical assessment.

Insight 6

The last insight in this series is to empower the patient. By helping them understand their pain, why it is warning them and how they can respond ... you empower them to ​help themselves. They will still rely on you for advice and guidance, and at the same time they will feel less anxious and this will reduce their pain experience.

And remember ...

Featured Bonus: Receive our exclusive ONE-PAGE 'cheat-sheet' on these 7 winning insights to print out and use in your practice AND also get a second bonus, the Pain Matrix, a simple tool to help you think when you're assessing patients with pain.

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