What Is Pain?
Reading that question, there are undoubtedly many different responses evoked in the reader based on his/her own unique life experiences. One could quote the dictionary: “pain is suffering or discomfort caused by an illness or injury.” One could be political: “Pain is trying to reach across the aisle to get a bill passed.” One could be philosophical: “Pain is the only thing that exists, all else is meaningless.” And one could get cheeky: “Pain is trying to live with my ex-wife!”
Whether one defines pain narrowly, broadly, with examples, or with ineffable feelings, everyone knows what it is. It simultaneously drives us, limits us, and even the potential of it can be an ever present reminder of whether or not something is worth doing. So if it is such an integral aspect of life, why is it so often demonized?
Going to a sporting event of any kind, one will undoubtedly hear about pain. Whether the pain should be pushed through, whether the pain is “worth it”, whether the pain is worthy of even acknowledging.
The point of this blog post is not to understand pain at the level of a neuroscientist or a deity, but rather to understand how we can work with this ever-present force. The big question that this blog post will attempt to answer is: if pain is an integral part of our daily lives, what can and should we do about it?
The answer to the question is another question: what does the person in pain want to do?
To illustrate this point, some examples will be necessary.
A senior high school football player sprains his ankle 2 weeks prior to seeing a physical therapist for rehab. The football player states that the pain isn’t too bad, and that he could live with it if he had to. He just really wants to get back before the end of his team’s season. He doesn’t plan to play football in college and this is his last year playing, so he’ll have plenty of time to rest it and fully rehab it afterward. He has had ankle sprains in the past, and this one isn’t too bad. From the evaluation, the football player’s ankle is completely stable, very strong, and the only “issue” remaining with the ankle is pain. In this case, the football player understands where the pain is coming from, understands the basic healing process and is ok with the risk of this pain continuing on for an extended period of time. He can live with it. His goal to return to the field for his senior season is stronger than his goal to eliminate the pain completely. So the therapist and player can move forward with a treatment plan based on these parameters.
This player returned to the field after two weeks and completed the season without incident. After following up a year later, the player reported that now in college, he plays recreational sports and does whatever he wants to do without pain.
A 25-year-old woman sprained her ankle while running two months ago. She rested it, but the pain continued and got worse and worse. It became unbearable, the ankle started to change colors, was excruciatingly painful to touch, and she could barely put any weight on it. She had many tests done at the doctor to rule out infections, fractures, and all sorts of other issues. None of the tests showed anything. She was diagnosed with Chronic Regional Pain Syndrome and told to trial physical therapy, but was also encouraged to just “put the pain out of her mind” by the doctors as there was nothing of note on any tests or x-rays. Most of her friends and family were very confused as to why she was still having pain, offering such helpful suggestions as that she should just “work through it” or to “think about all of the people who have it so much worse than she does”. The physical therapist that she then follows up with, asks all of the usual questions and she states that she “doesn’t care if i’m in a wheelchair the rest of my life, I just want the pain to stop.” Working off of that goal and slowly figuring out how she is responding to this pain, with a careful explanation of her condition of CRPS and general background on pain science, they work together to determine some goals that she can strive for over the next few days, weeks, and months; acknowledging that she truly does have pain and that her feelings about it are valid. Slowly, she becomes less defensive, realizing that she won’t have to fight the battle of whether or not she actually has pain, and is able to start to look inward at how this issue can be resolved. In this case, the pain is unremitting and unfamiliar, it is not something that the patient can just “work through”. There are emotional, physical, and mental pain elements that all need to be addressed before this person can start to set more specific movement goals. Within the next three months, this patient had returned to running 10 miles a week without pain.
These two examples are pared down from the true, real life examples they are based on. But if one looks at the two cases, one can see a glaring similarity: in both cases, the patient was listened to, and in both cases the patient was able to work with the clinician to set goals based on what he or she felt was most important to them. The clinician did not impose his own goals on the patient.
The bottom line is: pain is a part of life. It happens in the brain and in the body. If a clinician tries to set too many goals that aren’t important to the patient, the brain contained within this person, will not see the value and will not respond appropriately. Do you need to have a degree in pain science or be an expert clinician to help someone in this way? One could argue no, not entirely. Just listening can go a long way.
Disclaimer: The information provided in this post or anywhere on richardsonpt.com is no substitute for an evaluation by a licensed healthcare provider. Always consult with your doctor before beginning any exercise or diet plan.