What is Your Patient Saying?
Having been a physiotherapist for a number of years, I have spent a lot of time listening to patients in order to understand their pain. In particular, to find out how their pain impacts on their daily life. I’m sure many practitioners dealing with persistent pain have often found themselves in the same situation with their patients. But do we always really hear what our patients are actually saying?
Do we truly get to the bottom of our patient beliefs about their pain and do we understand the significance of the need to do this?
The Next Step…
If a patient’s recovery is not as you may expect, what is your next step once all physical causes have been ruled out? We often hear statements like “the pain just keeps coming back, I think there’s damage to the nerves from when I had the slipped disc,” for example. However, it’s important to question whether we know this to be the truth. Or, is this an assumption based on the fact the pain is persistent? Do we consider that the pain maybe persisting because an unconscious belief expects it to be?
Now all this talk of unconscious beliefs may sound rather vague or even unscientific to some. But considering that pain is an involuntary, automatic reaction to an apparent dangerous situation, is it any wonder that our unconscious thoughts can impact on pain?
The brain is designed to develop automatic patterns and repeat those patterns. It is hardwired to ‘save’ any experiences that we have repeated or those which have been associated with an intense emotional response. This happens so that we know how to respond quickly if that situation arises again. The prime role being to protect us from harm. Consequently, our brain builds up a complex system of programmed responses that happen automatically. The responses are so quick that they happen even before our conscious brain is aware of them.
Fight, Flight or Freeze
In response to pain, our automatic alarm system alerts us to danger and ‘our fight, flight or freeze’ reaction is triggered. Following this, our reaction is to move from the source of trauma causing the pain.
Until the pain is resolved, our alarm system stays on alert in an attempt to protect us. If this is prolonged or repeated, an automatic pattern can become established.
The Pain Chain
Our brain does not differentiate between helpful or unhelpful patterns. The brain only recognises that an action has been repeated, so it needs to be ‘saved’. Therefore, on occasions, persistent pain can continue even though the original cause of trauma has resolved. I refer to this as The Pain Chain. In my experience, this is more likely to happen if the clients alarm system is already on high alert for other reasons.
In this situation, the pain response becomes entangled with the alarm loop of other issues. Unless these issues are addressed, the pain messages continue. We can attempt to turn off the physical pain through physiotherapy. But if the pattern has already been established, this becomes much more difficult to achieve.
Case Study: Julia
This is demonstrated in a case study of client ‘Julia’. Julia suffered many years of persistent pain since having a prolapsed disc. She had Physiotherapy at the time of the problem which helped restore her to moderate function. However, she was left with sciatic pain. She had undergone two spinal injections and was taking Pregabalin medication to keep pain to a manageable level. She also regularly practised Pilates which helped to keep her moving. Despite this, she was plagued with intermittent episodes of severe, debilitating pain. She understood this to be because there was nerve damage following the disc prolapse.
We explored her beliefs further and uncovered that she had a huge fear of the pain worsening; she felt the need to be careful with what she did, in order to protect herself from further damage. She was fearful she would end up crippled by persistent pain and unconsciously protected herself with guarded movements.
We explored other reasons her alarm system may already be on alert, and discovered a chaotic childhood. Her past experiences had left her with the unconscious belief that there would always be another crisis. She was also holding onto a lot of unresolved emotion attached to the death of her father. Julia was completely unaware that her alarm system was on high alert or that these beliefs or patterns of responses could be contributing to her pain. She did however see herself as a worrier, it was part of her…how she always has been. Julia believed that could not be changed. A sign her alarm system was on high alert.
A Life Without Limitations
With my other hat on as a Psychotherapist, I was able to deliver some simple work with her using a technique called BWRT®. This technique allowed her to separate the emotions from the memories. BWRT® reset the alarm system to a more helpful resting level and create new, more helpful neural responses.
With this, the volume of persistent pain turned down and so it was then possible to begin more physical rehabilitation, this time the benefits of which were maintained.
Julia’s expectations of the programme had been greatly exceeded. She reported that her pain and its impact on her life had been drastically reduced. She maintains that her sense of wellbeing and confidence has greatly improved too, noticing positive changes in many areas of her life.
This is a case study of just one person, but it’s a pattern I see repeating in my consulting room on a regular basis. Clients arrive living a life in the shadow of pain, but discover through our work, a life without the limitations of pain is a reality.
The Key to Finding Freedom from Persistent Pain
If you read this and recognise someone with a similar presentation who is struggling to see a way forward, perhaps consider a different approach which may be the key to finding their freedom from pain.
I’d welcome comments or questions and would be interested to hear how others deal with similar clients.