Respecting vs Controlling with Persistent Pain
Updated: Nov 20, 2021
Alice sprains her ankle and decides to go to physiotherapy. Alice heals in 6- 8 weeks and is able to go back to enjoying her wonderland just like before!
Aladdin is getting old now and unfortunately suffers from a stroke. Don't worry because Aladdin will participate in a rehabilitation program to maximize his strength, mobility and ideally with some hard work he will be able to go back to riding his magic carpet, perhaps with some adaptive equipment.
Buzz lightyear has significant low back pain with sciatic nerve irritation. With the help of his physiotherapist and some specific movements and lifestyle changes he will be able to decrease his pain, eliminate the sciatic nerve symptoms and be able to travel to infinity... and beyond in no time!
Eeyore has also been having some low back & hip pain on and off for the last 3 months. He thought it would get better on its own, but it only seems to be getting worse. After about 6 months he finally decides that he can't take it anymore and he goes to see his doctor. His doctor prescribes pain medication, orders an x-ray and then writes a referral to physiotherapy. By the time Eeyore walks into the physio clinic its been almost 10 months of pain. During the initial evaluation, Eeyore states that he doesn't recall any specific injury, but that the pain started slowly, gradually got worse and now it seems to be spreading into his knee area. He also reports that his doctor said his x-ray shows some osteoarthritis (OA) and that he stopped doing his regular workout routine because he was scared of making the OA worse. After completing the full physical examination, we are able to rule out any major pathologies. We find some muscle tightness and minor limited range of motion in both the hip and back so we begin treatment. Treatment begins with education on OA, maybe some manual therapy and a slow progressive exercise program. Our overall goal is to decrease the pain, get Eeyore moving and return to his normal work out routine. Over time, we see that we aren't having much success towards our goals. We also learn that Eeyore is now seeing a Physio, Chiro, Massage therapist and is on disability because his hip & back are getting too sore to work (don't ask me what Eeyore does for work out there in the hundred acre wood but for the purposes of this story, Eeyore simply cannot work anymore because of his pain! haha). As we look further, we discover that maybe there is more to the story than just the physical pain that needs to be addressed. We learn that Eeyore's central nervous system has become sensitized and a whole wack load of factors are contributing to this (ex. depression, life stress, job dissatisfaction etc). Eeyore will require a different approach to treatment which he may or may not be ready for.
"The Pain Truth... and Nothing But! An easy to understand patient education handbook on pain management" written by a registered physiotherapist is a great resource for people suffering from persistent pain. Inside this handbook I found a quote written by Dr. John Sarno. This quote says it all. "Physical pain is designed to preoccupy the conscious thought in order to prevent the discovery of hidden and more painful emotional issues in the conscious or subconscious mind". This physical pain is real. Eeyore really does have back and hip pain that is seriously affecting his life, but there are more significant emotional issues that are causing the sensitization of the nervous system and ultimately (without getting into the anatomy and details) projected as physical pain. (Please note that this does not apply to everyone with pain lasting > 3 months and we must not be quick to judge. I am speaking about a particular subgroup of clients with chronic pain, fibromyalgia etc)
The field of chronic pain management and pain neuroscience education is evolving and this is fantastic. I am becoming more and more interested in this area because it forces us to think, assess and treat in a holistic approach. Healthcare practitioners are becoming more aware of different strategies to reduce persistent pain and these changes are making a very positive clinical impact. Quick fixes will not work and we need to go deeper if we want to make an impact. Despite this advancement, I am learning that as a physiotherapist (and as a human being in general), I cannot control people. I cannot force health on them. No matter how much of a relationship we can build, no matter how much trust is gained, no matter how patient I am, the desire to live a life without pain (or at least reduced pain) must come from within. My mission is to gently lead and quietly motivate towards your path of wellness. And be there, within my scope, when you are ready.