Why am I still in pain and why can you help me where everything I've tried so far hasn't?
I get asked this question a lot…
Today a client asked me if my background in physics and materials science changed the way I approached understanding the body because:
"The way you're describing pain and how it occurs is different to how the physiotherapist spoke”. (recent client, 2024)
Often client's have had a real journey before they've even arrived, and have tried so many therapies.
“I’ve been everywhere else, to my GP, for an MRI, to a knee consultant (insert any consultant here), to a NHS physiotherapist; I’ve tried osteopathy and chiropractic and nothing has been able to get to the bottom of why I’m feeling this way…"
"So why are you different?"
It made me reflect if I am different…
I wrote a dissertation on how pain occurs and what touch based therapies are likely doing mechanistically to the body-mind-spirit when we treat.
I wanted to be able to answer this question more deeply to hopefully satisfy my clients.
But first, I just want to say that I have great respect for all the professionals working to alleviate chronic pain and know that we all want to make a difference to the best of our abilities.
I do think they are extremely important when you need urgent care, or your care falls under their remit and surgery and/or MRIs are necessary.
Where I fit in: a holistic view...
Once we’ve established there isn’t (in our language) a “structural problem” that can be seen on a scan then we’ve got to dig a little deeper.
We’ve got to ask:
Why is someone in pain beyond the usual tissue healing time
Now they're in Chronic Pain....
This is my client - something has crept up on them over years.
Sometimes it started with an accident or injury - a memorable event that they can recount…
Sometimes there has been a surgical intervention.
Sometimes there have been steroid injections, physical rehab interventions and even NHS pain clinics.
The point is often when I treat my ideal client, they’ve got to me feeling like nothing more can be done, and it’s a good friend that’s convinced them to try me out.
And I’m very grateful to my current clients for their words of referral.
My clients keep me working by getting the word out that I really can help with chronic pain.
What am I doing that seems different?
To answer this question first we need to talk about pain.
And that’s coming from the authors that wrote one of the bibles on pain science and how it occurs.
So you can see already we don’t have a definition. - not a great start.
What we can agree on is that:
Pain is a complex multifaceted behavioural and physiological adaptation to stress (Chaitow, 2011).
pain is never solely physical.
Pain really does affect everything:
our identity,
our feelings
our thoughts
how we live,
our relationships,
our work,
our family,
our friends
and that all changes the way we move and interact in the world.
When you walk into my clinic I listen to all of you.
Because all of who you are is experiencing and living with the pain.
At the moment we have models of how pain occurs, it's not perfect but I will try to explain what we know.
pain is felt in the body across every system …
1. our fascial system: senses very small changes in pain & tension & integrates...
What is fascia?
It's a structure that’s very like the lining you’ll find when you break an egg and look at that film on the inside.
Fascia encases and weaves around every structure of our body on every level from the cell, to the organ, to the fascial web the organs, bones, muscles and tissue are all suspended in.
In a muscle that looks like this....
Fascia encases and wraps every single protein fiber to the whole tissue. It's the light pink in our image.
Our fascial system follows this pattern of patterns everywhere, across every lymph node, artery, organ, neuron.
You name it fascia holds, supports, encases, provides nutrients and connects.
1. Fascia is structural, holding us together across our entire body
It is the clever glue that holds us together suspended in a viscous life giving soup that has structural properties keeping us upright and mobile.
The days of looking at the body as a skeleton which everything hangs of are long gone.
2. Fascia dissipates forces across its entire web, saving us breaking
3. If the injury force doesn't travel through our whole system -fascia actively contracts to hold us as best it can
4. because fascia envelops every structure it can affect them all through it's tension
5. fascia creates our sensory world and pain
Truly, you are the only expert in your own body. Trust it.
2. our nervous system responds to danger and activates from the smallest nerve, all the way to the brain...
2.1 the smallest sensory nerves sense danger in different ways causing pain
We have many different sensory receptors in our body.
We have one's around joints that sense extreme changes in range of motion.
These flag up if a joint is moving too far too fast and potentially might dislocate.
These nerves lock down the tissues around them as a result.
We have others in the skin and around our peripheral nervous system (in the limbs).
These form 2 main important types that create our perception of pain. (Giordano, 2005; McMahon et al., 2013; Wall, 2002)
- (please read on at the end of this blog to hear more).
All of these fibers respond to negative stimuli from our environment and become sensitive to pain over time but at different rates.
The longer the stimulus or environment exists that stimulates these fiber types the lower the threshold to set them off gets in the future.
This process is called sensitization and can occur at every level of the nervous system. (Giordano, 2005)
Sensitisation means that we feel pain easier and easier with less and less input needed to feel the same or more pain.
*A-fibers: The first sharp pain & that then aches
The sharp feeling of a bone breaking is the response of these fibers tearing in the fascial layer that wraps our bones.
The change to aching pain occurs as pressure builds up on these fibers due to swelling from our immune response.
These fibers are fast in their response times travelling from the limbs to the spinal cord to the brain exceptionally quickly but don't stay sensitive for long.
These fibers respond to medium/deep pressure and stretching like what's felt in a sports massage.
*C-fibers: the slowest responders pack burning chronic pain
They are the slowest to respond and pass information up the chain to the spine -> brain.
They are the most important fiber type in chronic pain.
C-fibers sensitise in the presence of inflammation.
Which means they are active during or after an:
Injury
Disease state
Chronic stress.
The feeling associated with C-fiber activity is a burning pain and is thought the “second pain” after an injury occurs days or weeks later.
The most important thing to know about C-fibers is that they take a long time to sensitise, but once they get going they need a long time to de-activate and are usually kept switched on by inflammation!
C-fibers are respond most to pleasant, gentle, light and soft therapeutic touch.
2.2 Neurons in the spine receive these signals & can sensitise
2.3 In the brainstem pain increases or decreases based on intensity, duration and repetition
2.4 A lot of procession happens in the brain
How does pain become chronic?
Hopefully it is clear even from this small summary that pain can ramp up and ramp down not only at every layer of neural cells in the body and spine, but that our thoughts, beliefs, memories, experiences, attitudes, assumptions and expectations all integrate into our pain experience when the brain gets involved in the picture to create a complex instance of a person in pain.
This often changes our very identity and sense of self and our embodied experience in the world.
I haven’t even talked about what happens when the sympathetic nervous system become overactive - but needless to say it makes it even harder to wind down pain as we find ourselves in a low level fight or flight response permanently.
Complex trauma alongside chronic pain complicates still further.
hopefully it’s clear that pain isn’t all in the brain.
People experiencing chronic pain are NOT mad.
There are real chemical volleys, hormones and neurotransmitters that activate as the frequency, duration and intensity of a stimulus change and this happens at every layer of the nervous system (Eide, 2000; Staud et al., 2004; Van Griensven et al., 2013).
One particular new piece of research that intrigued me is that pain is now included alongside itch, temperature, hunger, thirst, emotions and internal homeostasis (how our body keeps us in balance all the time) (Craig, 2003).
Interestingly the author suggests that our emotions govern our physiological health and vice versa our health governs our mood.
So why are soft tissue therapies important?
Recent research shows that in chronic pain our awareness (interoception) of what's happening in our bodies is lowered and less accurate (Di Lernia et al., 2016; Craig., 2003; Farb et al., 2015; Hechler et al., 2016; Mehling., 2016; Staud et al., 2001; Staud et al., 2004; Turvey and Fonseca., 2014).
Mindfulness practices, which enable a person to gently become more embodied in a safe environment, map onto the same areas of the brain that have become stuck during chronic pain (Gibson, 2019).
Soft tissue therapies particularly myofascial release can increase safety, embodiment and mindfulness by increasing our internal (interoceptive) awareness particularly when the therapist is trauma informed (Cerritelli et al., 2020).
Massage also down regulates our fight and flight response, whilst up regulating our rest and digest (parasympathetic) response reducing sensitisation.
One of the most compelling arguments I found, is a therapist's ability to decouple the C-fibers feeding sensitisation into the spinal cord and brain with very gentle therapeutic touch -like that used in myofascial release and cranio-sacral therapies.
I am fascinated by the power of therapeutic touch in these circumstances and will never stop learning about it and how our whole body responds.
What else do I factor into my approach personally as a therapist?
I know both from my own clinical dissertation looking into the importance of being heard and validated; and my own lived experience that the tapestry of chronic pain and how it affects an individual's life is vast.
It can change our relationships both with ourself and others, our sleep, mood, anxiety, depression, thought processes, questions, self confidence, sense of reality, work, social life, family, ability to learn, ability to move, and ability to enjoy life.
With that in mind I will always within a treatment focus on listening and empathizing with an individual, of holding space for that individual’s whole experience as undeniable truth.
From there I will focus on trying to
help that individual make sense of what’s happened and slowly start to help them validate themselves from a place of trust and resiliency.
I do this by offering quality information from research that’s up to date.
But fundamentally because I know when I myself could start trusting that I was on the right path to recovery, then I truly started letting go of some of the most insidious and subconscious protection mechanisms that were chaining me to my own injury and pain.
That process of letting go and finding truth enabled me to start moving forwards into the present and the future and to be less held by past events.
It’s such a meaningful and beautiful process and it’s my job as a therapist to hold the space to create a strong healing environment where we can objectively look at the truth of what’s happening and start to make sense of it, from a place of safety, and trust that the body can truly heal some amazing and complex situations.
In complex chronic pain we need to actively engage in re-educating and re-processing a system that for one reason or another got stuck in a sensitized state.
Most of all though if you need help today, please reach out, we're here to help and would love to support you on your journey.
Much love
Carmen
Makepeace & Massage Ltd
Comentários