Saturday, February 02, 2008

About Point 3...

I feel I must take apart Point 3 of the "consensus on pain" a bit.
Point 3 states:
3. A pain experience may be induced or amplified by both actual and potential threats.

Bear in mind that this point was agreed upon from the perspective of a group of human primate social groomers, who don't want our presence to be threatening, and who want to see our work, i.e., the manual therapy part of it, as beneficial, pain alleviating. We wanted to point out that ofttimes manual therapy (exteroceptive contact) constitutes a "threat" to parts of someone's nervous system. We (collectively) want practitioners to realize this, and learn to back off appropriately, make contact gently.

However, if we look at pain from the context of a person with chronic pain, out and about, making his or her way in the world, coping as best they can with pain, the statement would be different. It would be something along the lines of "A pain experience may be increased OR decreased in the face of a threat, potential or actual."

People often have this experience. For example, consider a parent who has chronic pain, looking after a toddler, out window shopping. Parent's attention becomes distracted for just a few seconds, long enough for the toddler to run off out into traffic. Parent looks up, doesn't see child, experiences panic (sympathetic nervous system response), eyes sharpen accordingly and start scanning, parent spots toddler off the sidewalk in street, sees red bus coming (YIKES!) and adrenalin immediately kicks in - parent forgets all about being in pain, doesn't even "feel" it in that moment. A greater threat to "survival" - a possibility one's child might be killed - has kicked in, pain channels/pathways go silent, the non-conscious brain takes over the body, galvanizing its imperative to make the parent run like the wind and scoop up that child before the bus arrives to where it is standing.

Once the adrenalin is gone, the pain returns, but the person will recall that for a brief period of time (that felt like hours), they were completely distracted from their perception of their "pain", and something else was able to take over their body, to do what was necessary in the moment. In other words, for those few moments, they were ostensibly "pain free", as their system dealt with the larger threat at hand.

Whether a pain experience is increased or decreased by a "threat" will depend entirely on context, just like pain itself does.

Therapists need to be able to both convey this intelligently, and develop sufficient therapeutic treatment boundaries so as to constitute as small an exteroceptive "threat" as possible to their patients.

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