Tonight Horizon on BBC2 features, Can my brain cure my back pain?, presented by Dr Michael Mosley. Back pain is one of the most costly conditions, both in terms of the economics and personal suffering. Something must be done.
Can my brain cure my back pain?
Chronic pain is the number one global health burden (Global Burden of Disease Study), the driver for the creation of Understand Pain. It costs more than heart disease, cancer and diabetes put together. The question is why is there not more effort in society to change this massive social issue?
I hope that Dr Mosley will help in that direction tonight! We desperately need the right messages in society (see below for examples). It is the misunderstanding of pain that results in the wrong thinking and the wrong actions with consequent on-going suffering.
Of course we are more than a brain, so this is an interesting title. It seems that the focus will be upon placebo, which is understood biologically. That our beliefs and expectations amongst other things shape our perceptions is well known. Some view placebo in a negative way when in fact we all use the effects on a day to day basis. On the other hand, using placebo can be very effective when you align a person’s beliefs with the facts about pain. Equally the nocebo effect, the opposite of placebo, is very real.
Our reality is ours and constructed by ourselves via the existence of a brain and body and how the two come together. The mind is embodied, and the body is embedded in a society and a culture (with many sub-cultures), meaning we have to consider these interrelated features of existence to address the problem of pain. This is how informed clinicians work, focusing on the person as much as the condition, if not more.
It is always worth remembering that everything has a biology: a thought, a feeling, a sensation, an emotion, a movement, a perception etc etc.
To understand pain is to know that you have great potential to overcome your pain and suffering. This is the premise for UP, Understand Pain, as we have the knowledge and the know-how, but few receive it when they need it.
The pinnacle of our knowledge now emerges from the blend of neurosciences and philosophy. However, on basic terms, when we understand a problem, it is no longer a problem. Instead it is a challenge to face and overcome. Pain is no different. When the person knows how they have come to suffer on-going pain, including all the influences in their life, they can take that forward with positive actions each day to build towards a picture of success.
There are a huge number of practices that we can use to maintain the right course. Yes there are bumps in the road, but we can also develop skills to deal with those before resuming the direction of choice. One problem lies in the expectations that pain will not improve and life will not improve because people are told to ‘cope’ or that there is nothing that can be done. If your standard is set at that level, it can seem hopeless so why bother? Others put their heart and soul into it, but only just survive. It is not their fault because they know no better. Society MUST change this — it is not a should; it is a MUST (thats is a shout out!). There is too much needless suffering.
Pain is overcome by the person
Pain can only be overcome by the person. Pills, interventions and the multitude of offered treatments can have a role but are not enough. They are not the answer. The person has the answers, but needs help and encouragement to find it. That is our role as clinicians. Everyone has strengths that they use to get results. This is no different. It may not be easy, there will be really tough times, but with the preparation, planning and perseverance, with the right knowledge, wise actions and repetition, a person can gain momentum and achieve success.
It is the person who suffers pain, not the body part
Of course some people need more support than others in a range of ways. Pain affects all aspects of life: work, family, relationships, general health, finances and more. Anything that poses a threat or creates fear for the person will impact upon their pain experience both in terms of the biology and what they choose to do. We must look at the bigger picture of the first person experience; the whole person. After all, it is the person who feels pain, not their back or their knee.
Validating the story
The person in pain needs to know that you, the clinician, understand, believe their story and have solutions. We must validate what is said. If you do not believe the patient, you are probably in the wrong job. ‘Pain is what the patient says it is’ has stuck with me since my earliest interests as a nurse (McCaffery, 1968). Arguably this is the best definition.
In helping the person understand their pain we have to describe the embodied mind and the brain and all the involved body systems. In so doing, we often have to point out that despite discussing minds, emotions and perceptions, the PAIN IS REAL. It is embodied and it is felt in the location identified by the person. What needs to be understood is that most of the biology involved with the experience of pain, and there is nothing specific to pain, is NOT where you feel it. Much like most of what you need to watch a film in the cinema is not on the screen. Hence many of the approach, practices and treatments must reflect this fact.
Some pain facts
- pain and injury are poorly related (and they are not the same)
- pain is a need state that motivates action like hunger or thirst
- pain is related to the perception of threat
- most of the (non-specific) biology of pain is not where you feel it
- pain is an inferred state (and so is back stiffness) — it exists to help you learn and survive
- pain is just part of the way we protect ourselves; there are many other things happening as well such as a change in thinking, emotions, perceptions of the world, decision making, movement etc
There is much more, but this gets us going in the right direction.
Onwards with science, sense and great hope
There has been huge advancement in understanding of pain. The problem is that it has yet to reach the masses in a practical way. It is from this problem that emerged my purpose with individual patients but also on a wider scale with Understand Pain.
There are three important steps people can take. Understand their pain, learn the practices (supported by the right treatment) to face and overcome the challenge, and build wellness, which is our greatest buffer to life’s difficulties. We want to spend as much time as possible in great states of joy, pleasure, excitement and love (there ma many more!). And when we shift into a suffering state we want to address the needs, and change gears or states back to a great state. These are skills and practices that we should be taught from an early age. That would have served me better than algebra!
So onwards we go, focusing on a picture of success across the globe, taking each step with purpose. A world that understands pain is one that experiences far less suffering, has more resources for social needs, and encourages people to adopt an appraich to overcome pain by living life and building wellness. This does not always mean we are pain free because it serves a purpose. But it does mean that the person is suffering less and less by filling their capacity with more and more meaningful activities. What would you like to fill your life with?