We develop beliefs about pain very early in life through experience of injury, by the things we are told by significant others and via observation. These become ingrained and emerge later on when we experience a painful situation. This is part of how we decide what we should do when we are injured. At some point, we have learned that if we knock our elbow on the door frame, we should check it out by having a look, rub the area to make it feel better and move it to ensure that it still works.
Our culture plays a significant role in the development of our beliefs. This includes the meaning of pain and what is signifies and how you should respond; e.g./ ‘the stiff upper lip’. These messages like many others are passed down through the generations. In a sense, the beliefs spread much like a virus, or others such as Richard Dawkins describe the ‘meme’, which is a construct that is passed from person to person, and much like a gene can self-replicate and mutate.
The meme that is, “Don’t bend your back if it is painful” has become a widespread belief that I often hear in the clinic. If you have acute low back pain with accompanying spasm, the chances are it is going to be difficult to move, so bending may not be an option. We do condition very quickly as humans and construct a story from the facts, albeit the story may not be true, but it makes sense at the time. For example, on sending an email, the response does not come back immediately and therefore the receiver is rude, uncaring etc. That is the story whereas the fact is that you have merely sent an email. There is a significant difference, the former creating discomfort whereas the latter is easy to accept.
On bending if we experience acute pain we can quickly assume that bending is dangerous. This maybe confirmed by someone you go to see for some help and very soon this is a strong belief that guides our choices of how to move.
This message has spread across many cultures and could be termed a meme or even a virus. How can we change this? Through education and creating positive experiences for people to then inherently know that they are safe to move in particular ways. All of this takes time and perseverence as the message predominates. However, as we know that memes can mutate as can viruses, we should seek to culitvate accurate understanding of pain with the continuance of resaerch and translation into clincal practice. The idea of the meme then, can be a useful way of thinking about the reconceptualisation of pain for better treatment and care.