The Mystery of Pain

Addressing Pain is an essential part of my medical massage and qigong practice. On September 8, 2017, I attended a lecture on the Mystery of Pain by Douglas Nelson, at the Oregon School of Massage. Mr. Nelson is the current President of the Massage Therapy Foundation, and has been in clinical practice in the Midwest for over 22 years,

Here are my takeaways from the talk.  The audience is LMT's who want to better treat Pain, but the information can also help patients seeding treatment to clarify how therapists can best help.  My emphases are in bold and in italics are my understanding of how to translate the takeaways into more effective Pain treatment.

1. Pain is a global health problem.

• 1 in 5 people suffer with pain every year
• 1 in 10 have chronic pain every year
• 100+ million people have chronic pain
• Annual costs of treating Pain are greater than the costs of treating cancer, heart disease and diabetes combined

2. Pain management has unique challenges

• Pain is complex - it affects people on biological, social, psychological and spiritual levels
• Approaches must address the "whole person", failure to do so will escalate other problems (e.g, the opioid epidemic)
• quality of life is lower for chronic pain patients than patients with GI disease

3.  Therefore, treat Pain as a mystery rather than a puzzle. 

• A mystery is something to be unravelled, There is a story and it will unfold.  The client learns to heal him/herself.
• With a puzzle, if you fit the right piece in, you have solved it, The therapist fixes the client.
• A broadbased, curious, iterative approach provides more options for the client to heal..

4. Pain is different from nocioception

• Pain is the perception of aversive or unpleasant sensation
• Pain is the brain's response to a sense of DANGER
• Nocioception is the CNS signal of tissue damage

5. The Brain wants to provide a story for the Pain

• If client didn't see what happened in an attack or accident, client does 17x worse in recovery that someone who did see what happened
• Muscles tense in anticipation when an event is foreseen (they take the injury and muscles heal relatively fast - more blood flow)
• If event is not foreseen, joints and ligaments (which don't heal as fast) take the brunt of trauma
• Psychological damage (e.g., PTSD)  is more likely when an injury is not anticipated (e.g, buddy gets blown up in war as walking down street)
• If no one can provide story for the Pain (e.g, Chronic Pain) and you believe you cannot be helped, you will be right

6. Areas of the brain that fire in chronic pain normally process

• images
• cognition
• movement
• sensations
• memory
• beliefs

7.  The brain is neuroplastic

• Massage sessions provide new stimuli for the brain in all of the above.  These are all avenues to reprogram the Pain.
• Massage can help the brain learn new responses to what was formerly noxious stimuli

8. Massage is uniquely positioned to address Pain on many levels.

• Physiologically, massage can
  • trigger the relaxation response and activate rest and repose
  • increase circulation of blood and lymph for more rapid healing of muscle and connective tissue
  • inhibit negative nerve responses and highlight positive sensations - clarifying the body map
• Touch is a social, and emotional and spiritual connection that can
  • reduce stress
  • convey acceptance and belonging ("you are not alone")
  • decrease anxiety and depression
  • increase happiness (if you make someone happier, they are in less Pain)
• Kinesthetically, massage can individuate muscles so that they work more efficiently and not stuck together as a unit working against itself.

9.  Patients in Pain want answers to questions

• What is wrong?
• How long will it take?
• What can I do? (Self-care suggestions)
• What can you do?

10. If you don't know, tell the truth, give options, and answer with authority

• In 3 months, if  see you once a week, I expect to get here
  • set short term and long term goals
• Answering too generally, ("everyone is different") is a non-answer that makes patients uneasy
• Ask what you can do to improve functionality (quality of life)  "what does the patient want to do that s/he can't?"

Addressing Pain is an essential part of my practice and I am always seeking to learn more.  If you would like to schedule a consultation, please Contact Me