The medical community's understanding of the experience of pain has changed 180 degrees over the course of the last century. Descartes was one of the first individuals to start to piece together the notion that there was a chain of events that occurred when a person was in pain – he began what is known as the biological perspective of the study of pain (you touch a fire, and your finger tells your brain “ouch!”). Since that time, we have expanded our understanding of the study of pain from a strictly biological perspective to what is now known as the biopsychosocial model of pain. The biopsychosocial model suggests that it is not only the biology of what happens within our bodies that affects the pain experience, but also our thoughts, feelings, beliefs, and emotions. When a person is in pain for an extended period of time, those psychological components start becoming more pronounced and start to really influence our mood, relationships, motivation, jobs, and outlook on life.
Keele University has done work looking at these outside influences of pain, and has developed tools to determine the degree of influence these psychosocial factors have on your recovery; more specifically, these perpetuating factors include: depression, passive coping, poor self-efficacy, catastrophizing, and high fear avoidance beliefs.
But how do these things actually affect the pain I feel on a daily basis??? It certainly varies from person-to-person, and most of these perpetuating factors are interconnected. Let me provide an example:
Michelle R. works a sales job that involves large amounts of time spent in her car commuting, sitting at a desk, and sitting on airplanes jet-setting from city-to-city attempting to hook new clients. One morning, after getting out of bed, Michelle feels a sharp “popping” sensation in her low back, followed by an intense burning in her right leg (Pain! This can't be good!) She goes to see her medical doctor who appears apprehensive because she is in such severe pain. He orders an MRI, muscle relaxants, and anti-inflammatories and tells her to take it easy for a while. It turns out, her MRI shows a herniated disc pressing on one of her spinal nerves, causing that “Sciatic” pain down the leg. Out of fear of hurting herself more, Michelle continues to take it easy after the first few days. She stops going to her yoga classes and cancels her appointments with her personal trainer. After a few weeks, Michelle notices that she is still in severe pain. She begins to doubt if the pain will ever go away and starts to think that “this is just the way its going to be from now on” - very depressing! What's next, surgery???
When we look at Michelle's disc herniation and the series of events that took place after the injury, the feelings and emotions she felt were certainly reasonable and normal given the circumstances. When we look at Michelle's “pain experience” and compare it with our list of perpetuating factors, she appeared to be fearful of activity, which led her to take a passive approach to rehabilitation (partially at the recommendation of her physician!) because she catastrophized what would happen if she were to be active; in turn, these factors furthered her pain experience and led her to lack self-efficacy that she would every be active again, and become depressed.
But how did this cause her pain to persist or worsen?
Through research, we know that most spine pain is not life threatening or because of serious pathology (97-99% of presenting cases). Additionally, we know that most musculoskeletal spinal conditions respond well and heal with activity and movement. Michelle's fear of activity and hurting herself more, and passive approach to rehabilitation actual caused two things to happen – 1. Her body began to decondition as a result of being sedentary, in turn, it makes her more likely to be re-injured in the future; and 2. it increased her sensitivity to pain – when we don't expose ourselves painful experiences, in time we become hypersensitive to them because our body hasn't had an opportunity to adapt and problem solve the sensory experience.
These thoughts and emotions perpetuated Michelle's pain experience, and in turn her condition, which likely would have healed with a little bit of exercise and the correct guidance, in turn became a much difficult thing to treat.
Next time you recognize yourself experiencing these perpetuating factors while having a painful experience, it is important to acknowledge, first-and-foremost, that those thoughts and feelings are completely normal and understandable, but then admit that those thoughts are not going to aid your in recovery. If you have a spinal injury, seek the advice of a doctor with a thorough understanding of the spine, who is not only compassionate and committed to your recovery, but who also does not use fear to motivate you to become dependent on their care. The goal should be to allow you to return to doing the things you love to do, as quickly as possible.
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