Why do we feel pain?
The experience of pain is multifactorial. Pain science teaches us that it takes more than tissue damage for a person to experience pain. There need to be 3 separate factors in place for a person to experience pain. These factors may include stress, anxiety, catastrophizing, feeling loss of control or diminished agency, and fear. There are more to list, but you get the idea.
Thinking about this reminds me of multiple clients I have worked with whose experience of pain dramatically changed with what seemed like minor physical adjustments:
- Clients whose fear was alleviated through a better understanding of their condition.
- Clients whose agency was restored when they felt heard and were able to take actions that they understood for their improved well-being.
- Clients who felt supported through advocacy.
- Clients who were medically gaslighted or told there was nothing to be done. Who felt hope and improvement when they experienced holistic treatment.
You can read about Susan’s story in Safe Movement for All Spines, Chapter 10, as an example of this.
Jane’s Story
Another client case that demonstrates the intricacies and nuances of working with pain is Jane’s story.
Jane came to me for help with her chronic low back pain from an L4-5 anterolisthesis and stenosis. She was very happy with her progress, pain reduction and strength, and then “it” happened: she went golfing and felt painful spasms in her back again.
Afraid to do anything, and in terrible pain, she went to the ER. She told me that they gave her pain medicine, but did not x-ray her spine. This is so common, I am no longer shocked when people I know go to the ER with a possible back injury and are sent home with pain meds and no imaging.
Self Advocacy
She was afraid that she had made her anterolisthesis worse. Considering her multiple spinal pathologies, and the degree of pain she was experiencing, I decided to help her advocate for medical imaging. She did not know what to say, so I texted her and told her what to say to her doctor, to advocate for herself. I told her I didn’t care of she read it word for word from her phone:
“I was doing pretty well. Then I golfed, and I felt pain. The pain has not let up, so I am concerned that something has changed. Since I have a spondylolisthesis and osteoporosis, I think it is reasonable to rule out whether the anterolisthesis has changed, and rule out a compression fracture.”
Jane read this to her doctor, and was referred for x-rays. The x-rays did, in fact, rule out a compression fracture and any worsening of the anterolisthesis. But guess what? As soon as Jane found out she had not harmed her back her pain reduced almost 75% overnight. She told me she was “doing better, not so overwhelmed, and your advocacy for me was A+!” She further said “interesting that I am not having the same pain response from it that I did before.”
Since she had noticed the immediate difference and was open to a deeper conversation, I offered her this: “going through the process of ruling out anything really structurally wrong has settled your nervous system. You are no longer in a fear response in your deep neurology and that releases chronic holding patterns and tension and stress so that your body can direct more energy towards simply healing.”
She responded, “Oh goodness. Beautifully said. I was stuck in that fear & needed support to move forward. I shall copy that into my journal.”
Nothing changed about Jane in the 24 hours before and after the x-rays EXCEPT that she felt heard, felt that she was not alone, felt supported, and was given the evidence she needed to release her fear that she had damaged her spine.
The Lesson Learned
What this story teaches us is that, sometimes, our best strategy is not to try to “fix” something, but to try to help the person we are working with by listening – both to the surface story, and the story underneath. Sometimes our best strategy is to help a person gain a better understanding to alleviate fears, moving with them from co-regulation to a place of agency in their lives.
Want to dive deeper?
Join Gwen in Foundations or the Safe Movement For All Spines Mentorship.