Updated: Mar 16
*Pain education is not intended to be a solitary intervention. Pain education is best when applied in adjunct with traditional treatment and prevention strategies.
There were a couple important reality checks that I had while in PT school about the complex reality of pain.
The first occurred on a neuro education outing. As a class, we had an opportunity to head to the famous Rancho Los Amigos Rehabilitation Center for a day to learn from the neuro PTs their craft of ASIA scale testing, transfer training in their room full of plinths and get exposure to the gait lab. During one of the activities a physical therapist mentioned chronic pain following a spinal cord injury (SCI). She mentioned they had some success at Rancho with the use of projecting an image of a person walking onto the body of the person with the SCI and using a mirror to reflect the patient’s head/ face above the image of the walker. I found this mysterious and fascinating. I relegated this to interesting but not necessary info or passing my courses and moved on.
Later in my program, my orthopedics instructor gave us information on different types of pain. The information outlined different types of pain depending on the cause and longevity. I was astounded. I had always thought that pain results from injury and when an injury is healed, pain goes away- period. I thought that my role as a Physical Therapist was to help folks heal from their injuries, thereby resolving their pain.
I held these handouts in school delicately- I saved them, as I did all of my coursework in pre- digital world, in a dense 4-inch binder containing all of my orthopedic notes, labs and research. And when I wrapped up school and passed my boards, I put the binder on a shelf- barely referencing it through the years until I finally got rid of it during one of my many apartment moves in the bay area (I moved 6 times in the 7 years between graduating from PT school and starting my practice in 2013- poor baby Trina!). This is all to say, that talking about and understanding pain is difficult. It takes practice. Let’s not shove it on a shelf to collect dust.
Take a deep breath and lets do this!
Pain, though a frequent experience of patients in a PT environment can be a straightforward biologic event, but it is certainly not always. In my previous pain blog (waaay back in December of 2018) I outlined the two models of pain. A super quick review of the two pain models are (per NOI US 2016):
Biomedical Approach: intuitive, extremely successful for many diseases, broadly based on the premise that illness is strictly a biological process that can be cured
Biopsychosocial Approach: relatively new, unity of three domains attempted. Pain experience is influenced by biological, psychological and sociological behaviors and experiences of the patient.
Biopsychosocial approach to pain understands that many different factors have an influence over the felt sensations in the body.
The biopsychosocial approach suggests that there are 7 different categories that inform your body about what kind of sensations the body will create and the brain will pay attention to.
The categories are below:
1) Things you hear, taste, touch and smell
2) Things you do
3) Things you say
4) Things you think and believe
5) Places you go
6) People in your life
7) Things happening in your body
Pain research and education through the neuro orthopedic institute suggests that the 7 factors listed above are either helping to increase or decrease a sense of safety in the body. Danger signals tend to be associated with heightened pain and safety signals tend to be associated with decreased pain levels in the body.
Take a moment and reflect on the above 7 items.
During this particular point in history, many of us are feeling more danger around us than usual. Here are some examples that rattle in my head:
Oh no I have to go to the grocery store again (#5)!
Did that person who ran by me on the trail leave air droplets I inadvertently walked into (#6)?
My throat is itchy and sore. (#7)
One of the most practiced factors I witness in myself is #4- things I think and believe. Beliefs and thought can be so innocuous. They happen at lightning speed sometimes- “my mom had back pain, so I likely will too”. One aspect of meditation I really enjoy (and occasionally really tire of) is watching my thoughts. Now, I tend to be a friend to myself and think “Do you really want to think that to yourself woman?” I also ask myself often "Is this true?"
Once you begin to understand the danger signaling associated with the 7 factors, you can practice finding safety signals with the 7- LOOK for them if you have to! Hunt them down.
They can be quite simple: Hiking in the open area with no folks around (#2); Having a great dinner with my partner (#6). Develop a practice of looking deeply into your safety signals. Nourish them each day if you would like to make a change in the felt sense of your body.
Please take a moment after reading this and come up with safety and danger messages around all 7 factors in your life. Be as honest as you can about what you normally think and you might notice patterns start to emerge. This is a really helpful beginning.
When you’re done with this work enjoy some deep belly breaths and do something nice for yourself- it is not easy to read or think about pain. Yet, I’m confident we will be more educated and feel safer in our bodies on the other side of this difficult work.
For more resources on pain information and education click here