For many people I meet, after I mention pain science in conversation, they look at me quizzically? Sometimes like a deer in headlights! They usually ask what is pain science?
Although I am beginning to hear the terms pain science mentioned and I read about it in news articles more and more, it still seems to be used and linked with pharmaceuticals and how they have the answer for pain. I will attempt to shed some information on what I know of pain science and what it is all about.
Many years ago, I experienced real pain. The kind of pain that forces you to roll out of bed, crawl on your hands and knees to the bathtub so you can soak to be able to stand up. Try that for two weeks. For me, it was a long road of rehabilitation, trial, and error with an assortment of prescription drugs, injections of more types of drugs, sitting and lying on heating pads or ice packs, and a variety of exercises.
It was a very long road. Over two years. However, during that time, I began my own quest for healing and reading many different books on self-discovery and learning meditation. In my own way, I decided to just say screw this, I’m NOT going to stay in pain for the rest of my life! I am too young and still have so many things to discover. I realize now, looking back, I began to move and exercise even though I still hurt and changed and challenged my thoughts.
Fast forward twenty plus years to today and in some respects, I look back and realize I undertook my own version of confronting pain on my journey of recovery.
Thankfully some five years ago, I was introduced to pain science by Diane Jacobs. It has opened up my world to truth. Since then, there were difficult ideals that I faced as I learned about critical thinking and confirmation biases.
However, according to the International Association for the Study of Pain, pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
So, let’s break this down a little more than what the IASP says. Pain is a biopsychosocial experience. What the heck is that? Bio means biological, our physical body. Psycho means psychological, our feelings and emotions. Lastly, social means the social aspect of human beings including how we function as societies and how we act in groups. In other words, the behavior of an individual who is subject to environmental stressors plays a very major role. Pain is considered as nervous system output, not an input (Melzack R 2001). Nociception and pain are regarded as two separate phenomena, as per the definitions of IASP.
Factors required for pain to diminish for the long term.
- helping the client to determine all the ways they live in their body that may be contributing factors;
- plenty of pain education, explanation, and empathetic understanding;
- support for the client that leaves them with a full internal locus of control; meaning they understand THEY are in control;
- a meaningful and properly handed out homework.
One of the techniques we practice is DermoNeuroModulation. This type of therapy is a structured, interactive approach to manual therapy that considers the nervous system of the client, the person with pain, from skin cell to sense of self. Techniques used are slow, light, kind, intelligent, responsive and effective. When we position the limbs and trunk, we affect deeper nerve trunks of the body and is combined with skin stretch directed toward fields of nerves that branch outward into the skin. The goal is to find a position that decreases the client’s pain.
Dermo means addressing the skin. Neuro refers to the nervous system and the term Modulation or Modulates means a change in output or input similar to levels in music. Practicing DNM does not regard structure or any tissue classified as structure tissue as being the cause of pain. When we view biomechanics, asymmetry of form, posture or weakness, these issues are simply nothing more than defensive outputs by the same nervous system giving rise to pain perception. In other words, these factors are viewed as defenses and not defects.
DNM manual therapy is a way for a therapist to actually place hands on someone’s body to help them with a pain issue and is more of a way of understanding what therapy can do, does do from the point of view of the nervous system of a patient (Björnsdotter et al 2009).
Some key factors to remember are that pain is always a unique lived experience. We have a biological self, an emotional self, and a social self as part of each human being and we can NOT separate them. Pain always includes sensory, emotional and motivational aspects. Pain is predictably unpredictable and many areas of life can contribute to pain. Most people know that pain can affect many areas of life.
In other words, pain is way more complex than we really understand. Pain has been a mystery ever since humans began thinking about it. When someone comes to our office and says they have pain, then that is what pain is to them!
There are aspects of pain that many people do not hear from their doctor. Pain is actually an alarm designed to get action from the body. Another fact is hurt does not equal harm which means you can hurt without any tissue damage to the body. Since pain involves many body wide systems, this means that they have the potential to alter how it feels.
Our goal is to provide the nervous system with novel input or stimulation to assist it to function more easily. Since no therapist can treat a patient or client manually except through the skin, all manual therapist’s work is an adjunct that if done minimally and effectively, it can help self-correction to begin to move in the right direction.
Another point to clarify is nothing in the body can or will change until the central nervous system agrees or concludes that it is safe to allow change to happen. DNM addresses the complaints of emergent or persisting regional pain (Treed 2008), correlated with tension patterns (whether visible to the therapist or felt by the client), palpable tightness in the tissue and tenderness within superficial tissue as felt and reported by the client in pain.
Every year, the IASP meets and discusses how to share the research they have discovered with health care practitioners and educators. This means we have opportunities to learn more and more about pain science.
Well, that may be more information that you wanted, but this is just the first of many more articles to come on neuroscience.
‘Til next time….
- DermoNeuroModulation; Treatment Manual; Diane Jacobs, PT; Europe 2016
- International Association for the Study of Pain: Taxonomy page: http://www.iasp-pain.org/Taxonomy
- Melzack R; Pain and the neuromatrix in the brain. J Dent Educ 2001 Dec; 65(12):1378-82
- Björnsdotter M, Löken L, Olausson H, Vallbo A, Wessberg J.; Somatotopic organization of gentle touch processing in the posterior insular cortex. J Neurosci. 2009 Jul 22; 29(29):9314-20
- Treed RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra K; Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008 Apr 29; 70(18):1630-5