“So pain science education isn’t a magic bullet, but it is a starting ground, a jumping off point, a strong and stable foundation upon which to build everything else up upon. It opens the door and let’s some light shine in, relieving some of the darkness we’ve been cowering in feeling lost and afraid, not knowing the way forward.”
An excellent blog on why manual therapists who often treat people in persistent pain (and as Jo points out who may have been there themselves) should pain science.
It made me think back to some patients I had in the early days of my manual therapy training before I began to pain science, so actually up until a few years ago. These were the people who had reactions to treatment that meant they had more pain after treatment, or different pain, unexplained reactions that left them upset and seeking answers and more importantly seeking help. It’s not like they had never experienced pain before, but neither of us expected them to be worse after treatment.
I wondered at the time if I had been the cause of their pain, a reasonable assumption given that my training had only ever promised to help me get people out of pain. I did everything I was taught and then some. I found the cause of their pain and I treated it. Theoretically I fixed it. So why did they have more pain?
Naturally, and to assuage my own guilt, I considered all the things the patient might have done wrong once they left my treatment room, after all I was only with them for an hour of their life so who knows what else they did that day that messed everything up?
Inwardly I freaked out that if my osteopathic training enabled me to remove cranial torsions, realign vertebrae and re-establish the axis of the heart with a relatively minimal touch, then perhaps I could, unknowingly, have put some vital organ under tension causing unknown amounts of trouble and strife for the patient.
I assured the patient that sometimes more pain after treatment was normal, but even I didn’t really believe that. I had no adequate answers and I had no solutions.
As it turns out my treatment (touch, context, words) may have in fact been the problem that day, but likely because my pain training, especially for persistent pain, was wholly inadequate for me to make an informed treatment plan for that person, on that day.
That’s not to say that my patients will not have more pain after treatment, some of them may. But now I have an understanding of how more pain can sometimes, temporarily, be a consequence of changing pain. Like Jo I’ve been through it personally without the benefit of that understanding so it’s hugely gratifying to be able to provide my patients with knowledge, strategies, support and context that might make the journey a little less frustrating.
Jo puts it nicely – “Pain science education helps us to recognize that we’re in the fog, to be aware of how pain is affecting our lives, and it turns on the headlights so we can start moving forward, however slowly.”