Is Pain-Free Enough?
“Hi mate, how are you getting on?” “Really well mate, pain-free” “Oh, that’s brilliant. How’s your return to full duties been?” “Oh, I can’t do that. Doing that job is what put me here so I’m never doing those movements again it will break me. I need to take it easy”.
What is pain?
Pain is a complex issue that is multi-factorial and involves social, contextual, physical, and psychological factors; yet a large approach to the treatment frequently provided by musculoskeletal clinicians is focused on simply reducing the sensation of pain (Wainright 2019). This is an approach that is also favoured by patients as a study by Setchell et al. in 2019 demonstrated that people with persistent pain view passive modalities such as ice, heat, and manual therapy more than active modalities such as exercise (Setchell 2019). While not validating an individual’s experience and never focusing on reducing pain would be reductionist and unhelpful, there is an argument that solely focusing on reducing pain with passive modalities, could be dualistic and not address the multi-factorial nature of pain. I ask during this article whether an approach that solely focuses on reducing pain is sufficient and truly people-centred. My aim is to open up a discussion that suggests potentially more appropriate ways we can aim for a full recovery, beyond a reduction in sensation.
The effects of pain
Pain is having a significant economical, societal, and individual effect on governments, employers, and individuals (Becker 2019). Pain is extremely distressing and statistics show a strong correlation with suicide, long-term sickness absence, and unemployment (Becker 2019) further shining the light on how pain worms its way into an individual’s life and spreads until it impacts all factors of well-being. Interesting research has shown that it is not just the sensation that causes people to feel down, depressed and isolated, it is the perceived limitation that comes with the experience of being in pain, shaped by thoughts, beliefs, memories, and self-efficacy (Boutevillain 2017). While I appreciate focusing on desensitization in the short term is essential for an individual’s lifestyle and overall well-being, I would argue that the passive modalities and some frequently used strategies for communication are not beneficial for long-term health, potentially contributing to the perceived limitations of sufferers as they fail to address the physical, psychological, and contextual barriers that are posed by full rounded recovery, especially in cases where a long-term history of pain is present (Belavy 2021).
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