The Pain Game

July 17th, 2017

Patients often come in with pain being the center of their life, with it dominating all aspects. It kills me every time, because this isn’t the way things have to be. The way the medical profession has handled pain over the last twenty years hasn’t done much to help things. Instead of discussing pain, acknowledging it for what it is, and moving towards a solution, we get stuck on the worst aspects of pain.  The way pain is stigmatized has created a pain problem, and it’s time for that to stop.

First and foremost we need to look at the way we treat friends and family currently on the path to solving their pain. I’ve had countless patients tell me that people have said “Oh my cousin had that surgery and she was never the same”, “You’ll never get better”, or “How will you get your life back together.” Seriously. Put yourself in that person’s shoes, is that what you want to hear? I highly doubt it. And it doesn’t help them see that this is all temporary. We all experience this process differently. Instead of stigmatizing something, ask how their process is going and encourage them. Let them externalize their experience and support them. Don’t warn them about your babysitter’s uncle twice removed who lost half his face after a knee transplant.

Secondly, we need to look inward and see how we look at our own symptoms. Far too often strong emotions like anger, fear, and sadness are attached to pain. And to some extent, that’s fair. But don’t let it rule your experience with pain. Pain is actually not an offender, it is a defender. It’s your body’s way of saying “Hey, this is too much for me right now, please back off just a bit”. Pain is not your body’s sign of damage, but rather that it is unhappy with something. Much like our moods this can be swayed by our hunger, fatigue, environment, and the weather. Pain is merely a dynamic, changing process in which your body forces you to acknowledge your limits. Without it we couldn’t function. So don’t be angry at pain, say thank you for what it does, and then work to get rid of it.

So how do we work to get rid of it? Lifestyle changes are just as, if not more, important than what occurs during your PT visits. While maintaining safety as much as possible – decrease your reliance on aids and assistive devices. As we increase our reliance on outside help, movement and activity become more distasteful, to the point of avoidance. This in turn has an adverse effect on our psychological states, fitness, and overall function. Resuming normalcy in your life, again with reasonable pain levels and safety, will have amazing impacts on moods, confidence, and eventually abilities. Showing that pain is malleable and not permanent helps break the fear/avoidance cycle.

Reversing the Pavlovian response seen with pain is critical to recovery and resumption of normal life. It is up to the physical therapist to guide this process, the patient’s support system to handle it properly, and the patient to take an active role in recovery.  It often separates successful patients from those who have their recovery times drag, and requires a team effort to address. But when it does, the results are amazing.