iSAW 02.03 Explain Pain

What do you know about pain?
Answer true or false to the following questions. When part of your body is injured, special pain receptors convey the pain message to your brain? Pain only occurs when you are injured? The intensity of your pain matches the severity of the injury? Nerves have to connect a body part to the brain in order for that part to be in pain? Is it possible to have pain and not know about it? The pain you feel is the same that your grandparents would have felt? Answers? According to David Butler, the co-author of the book ‘Explain Pain‘ if you answered true to any of the questions above, you are wrong.

Who is Dave Butler?
Imagine a 58 year old, balding, Aussie PT (see pic), who wears green spectacles, outrageously colourful shirts and trendy jeans and doesn’t mind poking fun at himself, and anyone else. Me and fifty other therapists attended the Boston workshop in the brand-new Spaulding Rehab Hospital in Charlestown (we got a tour). Dave’s Aussie vernacular included regular ‘f’ bombs. He loves to pick on kiwis and canucks (I bore the brunt of the sheep jokes). He is a natural storyteller and he confided that many of the explain pain concepts and metaphors were formulated with the help of pinot and shiraz (there was even an Irish top-up for our mundane afternoon coffee).

Is this the Truth?
Despite all this political incorrectness the Explain Pain relieving concepts are based on recent discoveries in neuroscience and have been clinically tested. As I have posted many times in the past, if we really had a handle on pain, especially chronic pain, we’d be better able to be in control of it. We’re not. The drugs and the procedures aren’t the answer. In fact, pain seems to be in control of us. A typical Butler statement was that pain increases in proportion to wealth. What’s that about? Some new ways of figuring out how to reduce or solve suffering in our patients needs to be embraced. His own method is to educate the patient using stories and metaphors to describe what’s going on in their body; explaining their pain.

What are the Consequences?
Will people get better with just an explanation of their pain, as opposed to a physical intervention? Maybe, but why not combine the two. People do need to move, stretch and exercise better. But, the movements should be fun, non-threatening and multi-directional. Imagine catching butterflies with your hands. Future posts will explore a new definition of pain, smudging, new thoughts on neuropathic pain, neurotags, and glia. While trigger points barely got a mention (Dave thinks trigger points are an American invention) I will attempt to marry neuromatrix science with trigger point science and road test it on my patients.