My guiding principle: Pain is intelligent and intentional – Part 1.
How you think about pain will determine how you treat it. Embody this principle and it will improve your efficiency and your treatment outcomes.
Chronic pain is intentional and intelligent.
My guiding principles are ways of thinking that have given me the ability to solve one difficult case after another. Here is some of that wisdom for you.
Conventional wisdom considers pain to almost always be caused by some kind of breakdown in the body’s machinery. As such, pain is typically considered to be a direct result of a ‘fault’ in the mechanics and subsequent inflammation, mechanical impingement or nerve compression. So when a patient experiences chronic pain the medical profession is immediately searching for whatever is ‘broken’. And so … all the scanning technology.
I am going to suggest that a huge percentage of chronic pain is not caused by the immediate structures (such as inflammation, nerve compression or mechanical impingement) but is secondary, mediated through the fascia and skeletal muscle … somehow. In other words the body intelligently ‘refers’ pain to the site of mechanical dysfunction or potential injury. So the pain is just the messenger. A very intelligent and intentional messenger.
Sound weird? Just give me a chance to explain.
Chronic musculoskeletal pain is still an enigma!
Now anyone who has worked in the musculoskeletal therapy industry for any time will concede that in many cases a musculoskeletal ‘pain’ cannot be seen on any scan. On the other hand often a scan will find a ’cause’ for the pain (a tear, inflammatory markers or degenerative change) yet when the tear, wear or inflammation is resolved and repaired the pain persists.
In other scenarios structural asymmetries are used as an ‘explanation’ for the pain a person is suffering, yet 124,890 people with exactly the same structural asymmetry live a full life never experiencing the same pain symptom?
Our understanding of physiologically ‘what pain is’ is evolving. We know for example that conventional wisdom used to say in regards to many structural injuries to ‘rest, rest, rest’ but now says ‘move, move, move’. Wait a minute. Isn’t pain caused by inflammation, and inflammation is aggravated by movement. Why does movement give pain relief? In short, we are still learning a lot about the enigma we call ‘pain’.
All of us: GPs, sports physicians and therapists of all sorts are used to answering the patient who asks:
‘Can we scan it to find out?’
With the response:
‘We can, and we will almost certainly find some things wrong, but they may have nothing to do with your pain!’
A caveat before continuing…
Now I am speaking broadly about chronic unresolved pain. I am not suggesting that inflammation around a tendon or bursa does not cause sensitisation and subsequently pain, nor am I suggesting that the pain associated with complete loss of cartilage capping in a knee (bone on bone) is not a painful inflammatory condition. What I am suggesting is that after treating nearly 6000 patients that a huge percentage of chronic pain is not directly caused by the visible tear, wear or inflammation but is a secondary mechanism designed to prevent permanent injury or communicate a degree of dysfunction. And being secondary it can be ‘switched off’.
Pain that can be ‘switched off’?
‘Switched off?’
What the…
This phenomenon is something I observe all the time. It was at first most noticeable to me when working on the neck with a patient seated. I was treating a patient who presented with months of pain in the mastoid, lateral neck and temple headache along with restricted movement (if you are a Myotherapist you are rightly thinking about a trapezius referred pain pattern).
Treating the patient seated, ROM to the ipsilateral side was restricted by 30 per cent and reproducing the neck pain on movement. Cross-fibre manipulation to the fibres of trapezius near the clavicular insertion for no more than 20 seconds ‘switched off’ the pain immediately. Immediately, no referral to the neck or head. Immediately, full range of movement restored. So immediate in fact, that I considered the muscle did not have time to ‘relax’. There was no stretching involved. No rest period. No heat therapy. In fact in most cases, not only is the pain pattern ‘switched off’ but the tenderness associated disappears, range of movement is restored and strength and proprioception restored. Immediately.
Let me give you a second example I see frequently…
Wishing you the best of success.
Timothy J. King
