To All My Clinicians in the Struggle I struggle with patients. Those patients that I am having trouble with are who I study the most. It’s that whole learning from your failures thing. In studying these folks, I have noticed an interesting trend. It doesn’t involve movement. It doesn’t involve medical history It doesn’t involve stress (though it always involve stress) Instead it involves language. I have noticed a few commonalities in how those patients who are either not improving or have been in chronic pain for some time talk. There is one shift, however, that I notice more often than not. Disembodiment from Your Sports Team I don’t really watch a whole lot of sports; I’d rather play them. Sports fans however, interest me. It’s fascinating how much ownership a sports fan takes in his or her team. This ownership is especially noticeable when things are going well. Think of the language one may use during the following instances: Huge victory – “We finally beat the Packers.” Draft Picks – “Our team got some huge prospects.” Championship win – “We are the champions….my friends.” Notice though, how oftentimes language may shift when a team is not doing so well. Huge loss – “The Bears lost…Again.” Draft flops – “I can’t believe they chose Steve Urkel first round!.” Championship loss – “They blew our chance of winning.” Robert Cialdini discusses this concept in his book “Influence: The Psychology of Persuasion.” When our team is winning, we manipulate our association to
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Explain Pain Section 3: The Damaged and Deconditioned Body
This is a summary of section 2 of “Explain Pain” by David Butler and Lorimer Moseley. Tissue Injury 101 When a body is damaged, pain is often the best guide to promote optimal healing. Sometimes it is good for us to rest, other times it is better to move. A similar healing process occurs for all tissue injuries. First, inflammation floods the injured area with immune and rebuilding cells. This reason is why inflammation is a good thing in early injury stages. A scar forms once the inflammatory process is over. The tissue then remodels to attempt to become as good as the original. Blood supply and tissue requirements determine how fast the healing process occurs. For example, ligaments heal much slower than skin because the former has a lower blood supply than the latter. This may also be a reason why aerobic exercise may speed up the healing process. If present, pain usually diminishes as the tissues heal. However, pain may persist if the nervous system still feels under threat. Acid and Inflammation The alarm sensors described here constantly work and often get us to move. Movement keeps our system flushed. When we don’t move or a physical obstruction is present (e.g. sitting), acid and by-products build up in the body tissues. Oftentimes we will start to feel aches and pains when we stay in a prolonged position, which is our body’s way of saying “get up and move.” Much like the alarm system, inflammation is a primitive way for our
Read MoreExplain Pain Section 2: The Alarm System
This is a summary of section 2 of “Explain Pain” by David Butler and Lorimer Moseley. Alarm Signals Our body’s alarm system alerts us to danger or potential danger. This alarm system is composed of sensors throughout the body, the eyes, nose, and ears. It is these sensors that are our first line of defense against harm. If one sensor fails the others take over. Most of these sensors are located in the brain and respond to various stimuli. Some to mechanical movement, some to temperature change; the sensors in the brain particularly respond to chemical activity. What is important to know with sensors is that they have a very short life expectancy of a few days. This cycling means our body’s sensitivity is constantly changing. It is with these life cycles that there is hope for those with chronic pain. Moreover, the rate at which sensors are made is normally stable but can change very quickly in regards to a particular stimulus. So if we take for example one with persistent pain, the rate at which pain sensitivity occurs can be changed. Nociception We lack pain receptors in our bodies. Instead, the various tissues have special neurons that respond to different stimuli. These receptors are called nociceptors, which translates into “danger receptors.” Nociception is occurring all the time, but only sometimes will it end in pain. Nociception is neither necessary nor sufficient for pain. The sensors correspond to particular neurons. In order for these neurons to become excited and
Read MoreExplain Pain Section 1: Intro to Pain
This is a summary of the first section of the book “Explain Pain” by David Butler and Lorimer Moseley. Intro The major premise of this book is that pain is normal. It is the way that your brain judges a situation as threatening. Even if there are problems in the body, pain will not occur if your brain thinks you are not in danger. Explaining pain can reduce the threat value and improve pain management. And the good thing about explaining pain? Research shows that it can be an easily understood concept. Pain is Normal Pain from bites, postures, sprains, and other everyday activities are more often than not changes in the tissues that the brain perceives as threatening. This system is very handy, as often it keeps us from making the same mistake twice. I personally akin this to patients as recognizing a certain smell and that smell reminding you of something. Pain is often the reminder of previous injuries. Pain becomes problematic when it becomes chronic. This pain is often the result of the brain concluding that for some reason, often a subconscious one, that the person is threatened and in danger. The trick is finding out why. Pain Stories Stories are some of the best ways to relate pain to patients. There are many cases when you hear soldiers sustaining major injuries yet charging further into battle. On the flipside, take a look at paper cuts. The damage is very miniscule; however, the pain levels are huge.
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