Guest blogger Georgie Oldfield, founder of SIRPA™, looks at the role of non-physical factors in our perception of chronic pain
Have you ever wondered why (or noticed that) many of your clients have persistent or recurring pain, which began while doing something they normally did without any problem, or maybe soon after? Or maybe they woke with pain, yet it persisted for months or even years? This is so common, yet are we really that fragile that we can cause ourselves damage while doing something as innocuous as bending, getting out of a car or turning over in bed?
Despite a lack of supporting evidence, musculoskeletal pain is usually blamed on physical causes, such as poor posture (for example, reduced lumbar curve or one shoulder higher than the other, and so on), muscle imbalance (for example, poor core stability or hypermobility) or structure (for example, spinal degeneration such as a prolapsed disc or facet joint disease). In fact no correlation has been found between pain and posture, structure or biomechanics (Lederman, 2011).
There are in fact numerous studies to demonstrate that degeneration – for example in the spine (Kim et al, 2013), shoulders (Connor, 2003), hips (Silvis, 2011) and knees (Kaplan et al, 2005) – are just a normal part of ageing. Although the development of diagnostic procedures such as MRI and ultrasound scans have been invaluable, often when ‘abnormalities’ are found, it is assumed these must be the cause of any symptoms present, even though often the symptoms don’t match the findings on the scans. In fact, the studies highlighted above, found that about 80% of people without pain also have these ‘abnormalities’.
It is now widely accepted that stress ‘affects’ pain, so addressing this will clearly help in the management of pain. In fact, when you ask clients to consider what was going on in their lives in the lead up to the onset of pain, many will relate this to a challenge they were facing in their life, rather than a physical event. Interestingly, a couple of studies (Christensen et al, 2012; Feyer et al, 2000) looked at the physical, biomechanical and psychosocial aspects of individuals’ lives and the only factor involved in the triggering of new episodes of back pain were psychosocial factors.
Another study (Castro et al, 2001) used personality profiling to see if they could determine who might develop whiplash symptoms after a placebo car crash, despite the fact that the force induced could not possibly cause any biomechanical injury. They found that they could predict with 92% accuracy who would have symptoms a month after the ‘accident’ – based on their personality profile.
Not only have personality factors been found to be a determinant of whether symptoms might persist or become more severe, so have greater exposure to past traumatic events; early beliefs that pain may be permanent; and depressed mood (Young Casey et al, 2008). Add to this the strong link between adverse childhood experiences and ill-health in later life (Felitti, 1998) – including chronic pain (Goldberg, 1999) – and you can see why our focus needs to shift from the belief that there is always a physical reason for an individual’s pain.
In fact when you consider Kim’s study (2013), the poor results from non-surgical treatment for non-specific back pain (Keller et al, 2007), plus the lack of evidence to support the use of spinal surgery (Nguyen, 2011), injections for back pain (Chou, 2015) and morphine for chronic pain (Berthelot, 2015), it is clear we need to change our approach to the treatment of chronic pain.
Chronic pain has actually been found to be caused by the activation of nerve pathways in the brain. This results in persistent activation of the fight or flight response (our reaction to danger), which can cause real physical symptoms in the body. Most people have experienced a version of this when their face turns red with embarrassment or they feel a ‘knot’ in their abdomen in a tense situation. When this normal human response becomes very strong it can cause very real, severe pain or other symptoms that can be disabling. Treatment consists of education about how the fight or flight response works; changing behaviour that might unintentionally keep it ‘turned on’; and working through current, and sometimes past, challenges that trigger our danger signals. Once the signals are turned off, the pain usually improves and often resolves completely, resulting in life-changing results for individuals.
As a physiotherapist who came across this concept 10 years ago, the results I have observed with my clients has completely changed the way I treat chronic pain and other persistent symptoms. I love the fact that the approach is non-invasive and we can help individuals recover through education and by becoming self-empowered and taking responsibility for their own health.
For references: visit www.sirpaconference.com/infographic
About Georgie Oldfield
Georgie Oldfield MCSP is a leading physiotherapist and chronic pain specialist, promoting a pioneering approach to resolving chronic pain through her SIRPA Recovery Programme.
Hear her speak at the 2017 SIRPA conference, Chronic Pain: The Role of Emotions, being held on 15 October 2017, at the Royal Society of Medicine, London. To read about leading experts who will be presenting at the conference and to book, visit www.sirpaconference.com/conference-programme/
NB: This article refers to persistent, chronic pain, as opposed to tissue-damaging conditions, such as cancer, fracture, infections and autoimmune diseases.