This article concludes the series on outdated pain theories by making an important point: “so what?”
It’s great to be a nerd and pick apart how things work and why for the sake of learning science, but what really drives a point home is discussing it’s relevance.
Why is it bad to hold on to outdated pain theories?
What’s the harm?
While some pain relief can be achieved using the techniques discussed in this series (and we’ll talk about why later), explaining pain with these outdated theories can actually cause harm.
If you haven’t read the previous articles yet, here they are:
- Outdated Pain Theories, Part I – Damage and Degeneration
- Outdated Pain Theories, Part II – Posture and Symmetry
- Outdated Pain Theories, Part III – Muscle Imbalances & The “Core”
These explanations for persistent pain assume that it’s caused by damage, degeneration, or abnormal forces. While such things can certainly cause pain, they do not adequately explain why persistent pain remains, especially after things have healed.
The common problem with each of these explanations is that they assume pain persists because of constant “pain signals”. But this isn’t exactly how pain works, and treatments based on them aren’t very effective for persistent pain. 1, 2
Unfortunately, many healthcare professionals still think of pain in these terms.
Pain, Fear, and Recovery
People often experience a level of fear about their pain. They worry about what might be causing the pain, and what it means to their well being. This is all normal, of course. But too much fear can be detrimental, causing undue stress and avoidance of activity.
When people have heightened “fear-avoidance beliefs” 3, they tend to think things like:
- “I cannot do physical activities which (might) make my pain worse”, or
- “I cannot do my normal work until my pain is treated”
- “Being careful that I do not make any unnecessary movements is the safest thing I can do to prevent my pain from worsening”
They avoid activity out of fear. When people specifically fear movement because they believe it may cause pain or re-injury, it’s called “kinesiophobia”. 4
When people have higher levels of fear-avoidance beliefs and kinesiophobia, it tends to negatively impact their treatment outcomes, delaying recovery and increasing disability. 3, 5, 6 Generally speaking, it’s better for people in pain to stay active, 7 and typically, movement helps injuries heal! 8, 9, 10, 11
Words That Harm
This is why healthcare professionals need to be careful with the words they use. 12 When someone is in pain, the last thing they need to hear is “your back is out”, “you have degeneration”, “wear and tear”, “your posture is malaligned”, “moving this way causes damage”, “your muscles are imbalanced”, “your core is weak” etc.
Patients often adopt the word choices and even the beliefs of the professionals they see. When professionals use scary “mechanical” and “degenerative” type words, their patients tend to have less hope, and more fear. 13, 14, 15
You certainly shouldn’t lie about the diagnosis, and they need to know if things are bad. If you are going to describe things in such terms, you have to be absolutely sure that’s what’s causing their pain, and that addressing it will help. According to the research presented in the previous articles, however, we cannot be so sure.
Words That Heal
Here is a great video of physical therapy professor Peter O’Sullivan working with a patient who came to him with significant fear-avoidance beliefs. This person had given up their athletic dreams and had even stopped working. Look at how O’Sullivan works with this person, and the effect it has on this persons life. Watch if you have eight minutes:
What people should understand is that when it comes to posture, alignment, symmetry, and muscle balance, the only “truth” is that everyone is different. There is no such thing as “normal”; just a normal range. And even “abnormal” people outside of this range can live their entire lives without a single pain problem.
People in pain need to understand that damage does not equal pain. They need to understand that they should keep moving. Our job as therapists should be to help guide them through this process.
It’s time to let go of these outdated theories and beliefs!
It’s time to learn some new science!
How things really work is actually far more interesting. Besides, relying on outdated theories does no good for the progression of science, or the public’s understanding of it. That’s just not good, for so many reasons.
How does pain work? More articles coming soon…
For now, check out the pain education section of this site. There are some quick videos near the top, which are a great starting point. Share the knowledge!
P.S. Thank you! – Over the last few weeks, I’m happy to say these articles were shared widely, providing an opportunity to connect with many other healthcare professionals. Many intelligent conversations ensued, and some of the topics made their way into this post. Thank you everyone for sharing my writing, and especially for the helpful comments.
References will be posted as a comment below, in the following format:
14. Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, & Dowell A (2012). The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. European journal of pain (London, England), 16 (1), 3-17 PMID: 21719329