Musings on pain – a book in progress (a)

I think and read about pain extensively. Not just the physiology of pain, but the whole affect upon the individual who can suffer in a multitude of ways. We have our own meaning of pain, although most people who I meet have difficulty attaching a sense of meaning to their experience. Broadly speaking, in persisting cases, the pain is deemed to be a thoroughly negative acquaintance that has hung around far too long.

The unwanted house guest, the irritating fly, the frustrating official or an enduring hammering from next door on a quiet Sunday afternoon.

Pain is an emotional and a sensory experience by definition and affected by the physical, the psychological and the social aspects of life, hence the contemporary term ‘biopsychosocial’. There are many influences, a number of which we are not even conscious of at the time. It just hurts.

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Spending a great deal of time with patients,
Listening and hearing the stories of pain and suffering,
Looking and seeing the movement and behaviour changes,
The guarding and protection,
By the brain that must be revealed as the source.

I have heard some incredible histores told to me by the person sitting in front. Listening to the story from the beginning, although often they do not realise that the start point was long ago, I am piecing together the threads and connections. Some of these may seem irrelevant but are actually playing a role in the current time. Every piece of information is received and scrutinsed, nothing discarded until one is certain that there is no involvement.

The classic pain text

This book is a collection of my observations and thoughts about pain. All of these fall back on the contemporary understanding of pain that was really ignited by Pat Wall and Ron Melzack. It is no longer enough or acceptable to think about pain without considering the active role of the brain and the integrated networks of neurons within the brain that can be termed the ‘pain matrix’. However, we do not wish to be too neurocentric about pain and must wisely think about the immune system, endocrine system and autonomic nervous system within our contruct of how the body is protecting itself. For the brain’s ability to defend us is magnificent, our healing powers incredible and our ability to learn phenomenal. Together this creates opportunity, certainly in treating and understanding pain. The emotional centres (limbic system) and prefrontal cortex that are part of the pain matrix can be targeted with ‘informational therapy’ that is high quality pain education that permits deep learning about the body. Changing activity in the matrix will change pain. This does not negate the need to nourish the tissues (muscles, tendons, ligaments etc.) with movement, hands-on treatment and exercise, but we are urged by the science of pain to look beyond the tissues.

RS

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