Pain is an unavoidable part of the human experience; we’ve all experienced pain and we will all experience it again. However, despite the inevitable essence of pain, we (humans) still don’t fully understand it.
This post is going to cover a more recent paradigm shift in the understanding the pain experience. First we’ll explore the new framework (a model and a theory) for explaining pain and then we’ll use it to look at the innate parenting response – what it is, why it is so effective and what we can learn from it.
Before I continue on, I should give a disclaimer that this post is geared towards healthcare professionals (specifically physical therapists). However, I’m going to keep this post short, simple and relevant to anybody who’s experienced pain (i.e. – everyone), so I encourage you to follow along if you’re interested.
What Is Pain?
The International Associated for the Study of Pain (IASP) defines pain as:
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
From this definition, we can gather that pain is:
- an unpleasant experience
- is multidimensional (sensory and emotional)
- is NOT necessarily equal to tissue damage
- is a warning system designed to protect us from harm
In the past, pain was thought to be equal to tissue damage (pathoanatomical model). However, we now know that this is not true. While biological factors (i.e. tissue damage) do play a role in pain, it is only one piece of the (very complex) puzzle (with many pieces). In fact, numerous studies have shown that you can have pain without tissue damage and tissue damage without pain. To better understand why pain is NOT simply equal to tissue damage we need to understand the biopsychosocial model.
The Biopsychosocial (BPS) Model
Simply put, this model looks at “health” (including pain) through the lens of biology, psychology, and social context. In other words, this model addresses the fact that health (and pain) is influenced by a complex interaction between not only biological factors, but physiological factors and social factors as well.
The biopsychosocial model has been validated through research time and time again. Plus, it just makes sense; our biology, psychology and social context are all intimately related and we’ve all experienced it. The pain science community has begun to embrace the BPS when it comes to explaining pain. This paradigm shift in how we view “health” now brings us to the Neuromatrix Theory Of Pain.
The Neuromatrix Theory Of Pain
This pain science theory works under the BPS framework – it takes into account that pain is multidimensional and is affected by biological, psychological and social influences.
This theory asserts that pain is generated in the central nervous system (CNS) and that pain is an experience that is created through the interaction of multiple stimuli (biological, psychological, and social). Essentially, this theory is based on two major ideas.
- the CNS (brain + spinal cord) generates pain, NOT tissue damage
- multiple parts of the CNS work together to integrate various stimuli (BPS) to produce a sensation of pain
Once our CNS draws on all credible information (biological, psychological and social), a few things happen.
- If your CNS senses danger, you will have pain response. The amount, duration, location and type of pain will vary based on any number of biological, psychological or social factors.
- Despite whether or not you perceive pain, you will take some type of action (i.e. motor response). This motor response will be comprised of voluntary movement (e.g. holding an injured body part) and involuntary movement (e.g. withdrawal reflex).
- After weighing all incoming information, your body will initiate a stress response. In other words, your endocrine system (hormones) will be altered, your immune system will be influenced and even your nervous system will be impacted.
The Parent Analogy
Before continuing, I need to acknowledge that I first came across this analogy on the website for the Institute For Chronic Pain. The discussion on parenting and pain resonated with me so much that I decided to expand the thought and make the comparison to physical therapy, so let me set the stage.
We’ve all seen it – a little kid is running down the street, trips, falls down and scrapes their knee. There’s a brief moment of silence as the parent holds their breath hoping that their child doesn’t begin to cry. However, to nobody’s surprise, the child feels pain and begins to cry.
What happens next seems to be an innate and universal parental response. The response seems general and unscientific at best, however, when we take a closer look beneath the surface, this natural response beautifully addresses pain within the context of the BPS model. While exact details and circumstances may vary, most parents will do some variation of these three things.
- The parent reassures the child (“it’s okay”)
- This reassurance lets the child know that their body integrity is not threatened and that the tissue damage (scrape) is not dangerous.
- The parent places a bandage on the scrape
- By attending to the scrape, the parent shows their child that they are taking their pain seriously (they are validating their child’s pain). Through attending to the physical wound, the parent doesn’t create the possibility in the child’s mind that something serious in the diagnosis may have been missed.
- The parent redirects the child’s attention with something positive (e.g. play)
- Through redirecting the child’s attention away from the sense of harm, the parent is able to occupy the child’s attention with pleasant experiences which help to further reinforce that the harm (scrape) is not dangerous.
In essence, this parenting response addresses the physical, cognitive and emotional aspects of pain and as a result, the child’s pain decreases (and even disappears completely). It is my personal opinion that as physical therapists, we need to take a lesson from parents and address pain through the lens of the BPS model. Using the same structure as the example above, let’s break down how this parenting response might look in physical therapy.
A patient feels pain and begins to cry seeks the help of a physical therapist.
- The PT reassures the patient that it is ok
- This reassurance can be achieved through active listening, reassuring words, welcoming body language, confident explanations and genuine displays of compassion.
- The PT examines the patient and addresses their complaints
- We can attend to a patient’s complaints through active listening and with a thorough examination.
- The PT redirects the patient’s attention with something positive
- Redirection of attention can be done through focusing on the positive, establishing a “game plan,” finding avenue for pain relief, introducing movement, beginning with non-painful movement and gradually progressing (i.e. graded exposure).
Hopefully this analogy made sense to you and helps you realize that while there is a lot of science behind the scenes; it’s not rocket science. When it comes down to it, our responsibility as physical therapists is to help our patients to the best of our ability.
Be confident in your knowledge.
Be positive in your attitude.
Be compassionate in your interactions.
And most of all, be there for your patients.
It wouldn’t be a Joe Rinaldi blog without a quote so here it is.
“Pain is inevitable. Suffering is optional” Haruki Murakami
Pain is a protective mechanism that presents as an unpleasant experience (influenced by biology, psychology and social context). We’ve all felt pain and we will all feel it again. However, keep in mind that while pain sucks, it doesn’t mean you’ve got to suffer.
Stay positive. Seek out support. Be there for others. Be there for yourself. Have some faith and trust the process.
Thanks you for reading!
Joe Rinaldi, PT, DPT