We have many beliefs that construct our perception of the world. Beliefs about pain are no exception as we try to make sense of an injury or the emergence of the painful experience within the context of a situation. The significance of our own pain beliefs cannot be underestimated when it comes to treatment and training. They need to be elucidated and often sculpted to enable change and hence pain relief, in particular when the pain has been in existence for some time.
Commonly, patients who have been suffering persisting pain become increasingly vigilant to body sensations. This is called ‘hypervigilance’ and often comes hand in hand with ‘catastrophising’, another long word that means the belief system has kicked in and considered the body signal to mean something dangerous.
To change a persisting pain state we need re-training of the systems that process the information from the body and those that create our conscious experiences; what we feel, what we see, what we hear etc. There are a number of body-focused strategies that we can use to target the process from simple rubbing of the painful area to more specific sensorimotor training techniques. We often refer to this as ‘bottom-up’. We can enhance the effects of the bottom-up therapies by preparing the brain so that it is receptive to the body work. We call this ‘top-down’, which is like ploughing a field so that it is ready for the seeding.
Preparing the brain is a way of desensitising the processing systems by diminishing the threat. Pain is a response, an output from the body resulting from the conclusion that there is something posing a threat to the integrity of the self. Initially this means that the patient must understand their pain and symptoms, including why they persist and what we can do about it. It is clear how this would start to reduce the threat value and hence pain in many cases—people frequently report an easing of the symptoms at this point.
Returning to hypervigilance and catastrophising, we tackle these problems with education and positive experiences. Developing knowledge of the biology of pain and the skills to deal with both body sensations and the thoughts that follow is absolutely key in the early stages, for this is what drives the next behaviour. In the case of fear, usually the next behaviour is avoidance. Avoidance maybe useful in the very acute stages to protect the healing body, but in a persisting pain state, inactivity becomes a problem and a barrier to recovery.
Many body feelings are normal. When we are sensitised these feelings can be amplified and linger. In part this depends upon how what we think about the sensation and how much attention we put on the area. Where our attention lies has a big impact upon our pain perception, so being able to say to ourselves, “that is ok, it’s just a normal body feeling”, e.g./ pins and needles, allows us to move on without rumination that creates further fright or flight responses.
It has become clear with the continued reconceptualisation of pain that we must rehabilitate both the body systems and our thinking. Our thinking is based upon beliefs that are grooved throughout life—genes plus experiences—and these drive our behaviours, most of which happen automatically, i.e. they are habits. Creating awareness allows an opportunity for change, something that long-term pain sufferers relish as they are desperate to break the cycle and move forward. Blending awareness with knowledge and skills means that the habits of hypervigilance and catastrophising can be broken and new habits formed that create the conditions for wellness, performance and living.