Issue link: https://www.massageandbodyworkdigital.com/i/1519088
As far as content is concerned, we've done a lot of work mining the wisdom of people with chronic pain who have now recovered. We asked them, "How'd you do it? What was important? What were the main things you learned that enabled you and empowered you to recover?" And that's been an incredibly fruitful research line. So, we've come up with four essential pain facts I think every bodyworker should know. ESSENTIAL PAIN FACT NO. 1 First, pain protects us and promotes healing. That might not sound very striking, but I would encourage everyone to think carefully about how that aligns with their understanding of pain. Because most people, when they think of pain, would more readily say "pain detects pathology or detects damage," but that's not how pain works. I could argue this in any context, that the evidence that pain detects damage is very poor. In fact, I would say it's absent. The evidence that pain occurs in order to prevent damage is very compelling. TL: This is the radical central thought. I think your TEDx Talk was about how decoupling pain from damage opens all kinds of possibilities and raises all sorts of questions. LM: I agree. And it presents so many opportunities for intervention if we really embrace that. So, anyway, pain protects us and promotes healing, and within that are concepts like peripheral sensitization in the presence of injury or inf lammation and the interpretation of a f lare-up, for example. ESSENTIAL PAIN FACT NO. 2 The second essential pain fact is persistent pain overprotects us and prevents recovery. Tied up in that are a lot of principles like central sensitization or what we would A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 31 now call nociplastic pain. The lived experience of anyone who's had pain on most days for more than a few months, like it or not, is that the system is winding up. And an inbuilt property of animals is that repeated protection. The protective systems get better at doing what they're doing. That's bioplasticity or neuroplasticity across systems. TL: You're saying that ongoing pain is also protective, that it's the system winding up and, in a way, learning. LM: Yes. And I would say, because of the way that neuroimmune networks, and I guess more specifically neuron-to-neuron and neuron-to-immune cell synapses, work at a cellular level means the more often we produce pain, as an organism, the lower the threshold to produce it will become, because our system learns how to do it better. So, then we have a situation that clinically we call allodynia and hyperalgesia, but neurophysiologically, we call it a reduction in postsynaptic membrane excitability. In clinical terms, in the consumer's words, we call it pain system hypersensitivity. So, it's assisting pain. TL: It's often talked about as the pain system going wrong or somehow getting stuck in a state that it "shouldn't" be in. But you've reframed that—you're saying it's actually also learning and protecting? LM: Absolutely. Yes, I'm emphatic on that. I think it's not going wrong. This is how it works, and it works like this in all of us. The speed with which it adapts will vary a lot between individuals for many reasons. But I will often find myself saying to people challenged by chronic pain that this is a normal response to an abnormal set of circumstances. In my view, it's not the pain system going wrong, and it would be a healthy debate with other people I have a deep respect for who say it is the pain system going wrong. I don't conceptualize it like that. I feel like it's doing something pretty predictable based on biological principles. And in a way, it's a moot "People are protected from doing things they actually need to do to fully recover because it hurts . . . That's why pain is so effective, because it stops you from doing things the system believes are dangerous." —Lorimer Moseley