Issue link: https://www.massageandbodyworkdigital.com/i/588318
Massage & the Five Pain Models Having a knowledge of pain models can help us better understand our clients' chronic pain issues. Through these models, we can more clearly see the factors impacting our clients and their pain, and give us guidance on how best to help them. 1. FEAR-AVOIDANCE MODEL In the fear-avoidance model, a pain sufferer views pain as a threat: something that is going to, or has the potential to, get worse. Fear causes the person to focus on the pain (hypervigilance), which then results in avoidance behaviors (i.e., staying away from anything that could potentially increase the pain). Avoidance behaviors can lead to disability, disuse, and depression. According to the fear- avoidance model theory, if you take away the fear, the pain sufferer can start to utilize coping mechanisms that will improve quality of life. 7 Recognizing if your client might be engaged in fear-avoidance behavior takes time. First, during the initial intake, you will need to gauge the client's activity level, both past and present. Has his activity level shrunk over time? Understand that the process of aging also affects activity level. It has been my experience that someone whose activity level is shrinking out of fear and avoidance will often not be willing to try new activities to replace old activities. Someone who is simply accepting the aging process is often looking for substitute activities. If you suspect your client is headed down the disability path due to fear-avoidance behavior, recommend a counselor, pain-management specialist, or psychologist. For those not open to additional help, you can encourage them to remain active in ways that do not trigger pain. For example, my long-term client Barry suffers from chronic neck and back pain. He manages his pain through light exercise, pharmaceuticals, and eliminating things that bother his back. His activity world has gotten smaller over the years. He used to enjoy going to the beach and swimming in the ocean. But the turbulence of the ocean bothered his back, and he gave that up. Then, he only swam in his backyard pool, using a snorkel so he wouldn't have to turn his neck. Recently, he announced he is closing down his pool for good because swimming now bothers his shoulder. Barry is not open to the idea of counseling. Time to write him off? Nope. Barry's feet still work. He likes walking. So, I'm encouraging him to walk. 2. ACCEPTANCE AND COMMITMENT MODEL If your client is fixated on finding the cure for his chronic pain, pay attention. A chronic-pain sufferer who is psychologically inflexible and can't change behaviors to support a long-term goal has a lower quality of life than a person who can accept his chronic-pain condition. 8 Acceptance doesn't mean the person has given up. Acceptance means that until there is a definitive cure (like hip replacement for chronic hip pain) the chronic-pain sufferer has decided not to spend his life chasing an answer that doesn't exist. Instead, he is choosing to participate in activities and work toward goals that give him a sense of well-being. When you're working with a chronic-pain sufferer who is fixated on finding a cure, making him understand that you're not the cure can sometimes be a challenge. Early on in my massage career, I thought if I did my job right, my client would be out of pain, period. If the levator scapulae wasn't the problem, it must be the upper trapezius; if the upper trap wasn't the problem, it must be the posterior scalenes, and so on. This fruitless search for ending chronic pain ended only when the client tried something different. Until he left, I would hear: "I think it's getting a little bit better, Mark." But, after some time, I realized the cure wasn't getting any closer. If you feel yourself being pulled into your client's unhealthy quest for a cure, tell him that, given his condition, you can only help with pain relief, not a cure. It is unethical to continue treatment with an incorrect, unattainable goal in mind. 3. MISDIRECTED PROBLEM-SOLVING MODEL I think my wife would agree that sometimes I don't worry enough, while sometimes she worries too much. According to the misdirected problem- solving model, in terms of human evolution, worrying is connected to problem solving—if one thinks about all the negative outcomes, one can figure out how to avoid them. In other words, if my wife and I were transported back 3 million years, I would have been lunch for a leopard, while she would have survived to pass on her genes. 9 92 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 5