By Carolyn Vandyken
Pelvic PT, Educator, Author
There are two camps in treating pain:
Tissue-based Camp of Treatment
Providers treat the tissues alone believing that there must be something bio-medically wrong with the tissues; if they can only mobilize, zap or anesthetize the right tissues, they will be able to change the pain. When the right tissues cannot be found to achieve this goal, these practitioners then medicate people to numb the pain and teach people pain management approaches to help them cope with the pain (and the side effects of the medication). Patients are often not given hope that their pain can change significantly or that they can go back to having a “normal” life . In fact, in 2015, at a University-based Medical Pain Clinic in Canada, one of my patients was told that all you can expect from treatment in persistent pain is that you can be 30% less bad (not better) and that you should never expect that your pain will go away. You will have to learn to live with it.
Psychology-based Camp of Treatment
Believes that chronic pain is anchored in the psychosocial piece and we just have to get patients to think differently or behave differently so that their pain will change. They believe that their pain is psychosomatic; I hate this term- either ALL pain is psychosomatic or NO pain is psychosomatic. Patients never consciously create pain for themselves; it is not in their heads. Even if our thoughts and beliefs are skewed, just changing those factors alone without changing the health of the tissues is unlikely to get a good result in persistent pain either. CBT or ACT alone, although helpful, is not any more successful in research studies for treating persistent pain than tissue-based treatments.
So what if we treat the whole person – their unhealthy tissues and their thoughts, beliefs, fears and tendencies to over-emphasize the importance of their problem? This biopsychosocial approach needs to happen AFTER patients are educated about pain biology, so that they truly understand how their pain system has become hijacked, and how they can claim it back again. The goal of treatment is to find the BIO-PSYCHO-SOCIAL drivers or threats that are causing the nervous system to stay sensitized and in a hyper-protective mode. No blame is shifted to the patient since the nervous system has structurally changed and adapted to create this pain state. Neuroplasticity means that we have the capability of changing the nervous system in both directions – for better and worse. Don’t forget that the brain is an organ too. It is plastic, and it can change.
Treatment of the body to address tension and weakness will help to change the inputs to the nervous system and should not be ignored; however, treating the tissues should involve approaches that empower patients to do things for themselves since this builds their capacity to take care of themselves. The brain can change, and so can the body’s tissues. The problem has been that the psychological camp forgets the physical piece, and the biomedical camp forgets the psychological piece and they both forget the importance of having an accurate understanding of how the pain system works. Within a biopsychosocial framework using pain biology education as the glue, we can develop meaningful changes to the nervous system, allowing it to do its job of protecting us from “actual” harm immediately, and quieting down the system that is over-protecting us from “potential” harm 24/7. This sensitized nervous system is a huge contributor to persistent pain, and it can change. Patients deserve to be hopeful that they can be well again.
Carolyn has practiced in orthopaedics and pelvic health for the past 33 years.
She is a McKenzie Credentialed physiotherapist (1999), certified in acupuncture (2002), and obtained a certificate in Cognitive Behavioural Therapy (CBT) in 2017.
Carolyn received the YWCA Woman of Distinction award (2004) and the OPA Distinguished Education Award (2015). She has been heavily involved in post-graduate pelvic health education, research in lumbopelvic pain, speaking at numerous international conferences and writing books and chapters for the past twelve years in pelvic health, orthopaedics and pain science.