Let’s play a word association game. When you hear the word “pain,” what do you think? Are they positive or negative thoughts? Since birth, pain has been associated with being injured, damaging tissue, danger…the list goes on and on. So when a patient comes into your clinic complaining of pain, odds are they are associating these symptoms with some of these previous thoughts. But what if there was a way to change how your patients perceive pain? I don’t mean adopting the “no pain, no gain” philosophy on treating, just maybe reinforcing the concept that, “pain does not equal tissue damage.”
How many of you have found a bruise on your leg, but cannot remember how it got there? Did you damage tissue? Of course you did, you can see the reminisce of ruptured blood vessels, so obviously something has been damaged. But the bigger question is the following: did you experience pain? Or what about a paper cut? How much tissue damage occurs? Not a lot, yet it can hurt like crazy. Being able to talk through examples like this may help your patients make the connection that although there may be “pathological” findings on imaging, it does not mean that those “issues in their tissues” are the source of the pain.
Now let’s go back to that bruise on your shin. What if you got the bruise scoring the game winning goal to win the championship; would it change your perception of the tissue damage? The pain typically associated with the injury may not have such a negative connotation anymore, because every time you look at it you are reminded of that game winning goal. And what if the role was reversed…what happens if you got that bruise while losing the championship game, think your perception of the injury may change?
A recent study by Benedetti et al dove a little deeper into this concept of changing our perception of pain. What if you were rewarded for your pain? That’s right, what if the negative emotional experiences you have when you feel pain were actually encouraged? Well the researchers in this study did just that. The source of the pain? A blood pressure cuff, inflated to the point in which it would create an ischemic pain. The lucky participants? Two different groups of subjects were used, both instructed to try and endure the pain as long as possible. The game changer? One group was told that cutting off the blood supply would be beneficial to the muscles and help them get stronger, whereas the other group was simply told to try and withstand the pain. The findings? The group who was told that they’d get stronger was able to keep the blood pressure cuff on nearly 50% longer than the control group. That’s a pretty significant difference!
Now the researchers go into talking about, “a positive approach to pain reduces the global pain experience through the co-activation of the opioid and cannabinoid systems.” Instead of getting into the neurophysiological significance of these systems, let’s talk about how we can use this study in a clinical setting. What if you have a patient who just had a total knee replacement, and is afraid to bend it. Instead of just telling them that they need to work through the pain, maybe you set small milestones for each week (ex: our goal is to reach 90 degrees of flexion at the end of the week), and praise them for all of their hard work once they accomplish these goals. Maybe you acknowledge how difficult it is right now, but reinforce the fact that better motion will allow for them to do things they’ve been wanting to do. Besides, motion is lotion after all.
So what’s the big take home message? The way our patients perceive their pain can significantly impact their lives, and as physical therapists, we play a huge role in educating our patients about their pain. Take the time during your next treatment session to talk a little pain science with your patients, whether they are a high school athlete with an ankle sprain or an elderly woman with chronic back pain, because everyone can benefit from knowing more about why they may be in pain. Remember, knowledge is power.