The concept of explaining someone’s pain early on in the treatment process always made perfect sense to me. If it were me, I’d want to know why it hurt, especially if it was continuing to hurt for some time. Initially I thought that people would want to know so that there was a sense of meaning, a purpose behind the pain that makes sense, ‘aha, I see, it hurts because ……’. Now we know more about the need to explain pain for a number of reasons and doing it well is important so that the receiver of the information can understand. I use several aids including a pen and paper (or iPad and stylus), the book ‘Explain Pain’ by David Butler and Lorimer Moseley and a further book by Lorimer entitled ‘Painful Yarns’. Both of these books really help me to explain pain in it’s most modern context alongside new research that is regularly published. There is now an e-book for Explain Pain and CDs are available.
So why is it so important?
Of course providing a sense of meaning and a good reason why it still hurts, as mentioned above, is very important. We will tend to cope better with an adverse situation if we have some way of explaining to ourselves what is going on (internal dialogue). A good test of our understanding is when we can tell ourselves and others the reasons behind the pain and why it persists. We want to know what is going on, if there is something we need to attend to or whether there is a pathology at play. Of course judicious investigations help with this although in many cases the results are normal despite the fact that it hurts. This clearly needs explanation, and with a modern perspective upon pain we can describe what is happening in the body to create on-going pain. This knowledge is being regularly updated with research and we must update our explanations accordingly.
Often associated with on-going pain are fears and anxieties related to movement, exercise, working and the future to name but a few. Interestingly, the part of the brain that deals with fear (the amygdala) communicates directly with the motor control areas, influencing their output. On a practical level, this means that a fear of movement will change the way in which you actually move. Anticipation and expectation of pain both have this effect and also amplify the pain perception. Think about how you walk on ice! Rigid, guarded and tense – more or less likely to fall over than if you walk normally? Dealing with fears and anxieties in relation to the pain is therefore important in promoting normal movement, part of desensitising a system that is inherently protective in these states.
All treatment programmes involve an element of exercise, movement and other tasks that are designed to promote normal sense of movement and self. In order to fully engage in any task we like to know why we are doing it. Explaining the pain and why a particular activity will help, assists in the engagement and necessary persistence. Rehabilitation of the neuromuscular system is a learning process, similar to playing a musical instrument or learning a language and requires repetition and practice.
Understanding that the are principles of rehabilitation and treatment alongside a time factor allows for a sense of purpose. Often the process requires habit change, for example fitting in exercises or postural correction on a regular basis, and this can take a little time to implement, along with encouragement and prompting. Knowing the healing time of tissue helps in the understanding of the longevity of the rehabilitation. This should always be described so that the forward journey can be perceived. If the presentation is more persisting and the tissues have healed yet there is still pain, the reasons for this must be explained for the reasons explained previously.
So, in summary, explaining pain and the process of rehabilitation is a key part of providing a sense of meaning, reducing anxiety, helping to develop effective coping and adherence to the programme, all important for success. The explanation must fit the bill and of course must be understood