Movement & Pain: Join ‘the movement’

The I in pain

Unlike communicable, dread disease, chronic pain is multi-factorial and rarely traceable to a single source. Also unlike disease, pain is not contagious, not shareable, not measurable, it is personalised and different cultures and socioeconomic groups vary in responses from high tolerance to highly sensitised. In a wide cultural and socio-economic landscape such as South Africa, pain can be difficult to describe with cultural, religious and language differences that create barriers between the experiencer of pain and the clinician.

Centuries have come and gone and theories have ranged from simplified deductive logic with Descartes dualistic model that pain is felt in the tissue, travels along the nervous system and to the brain to the more ancient religious outlook of pain as a punishment from the Gods (1). What then is the current consensus of pain? According to the international association for the study of pain (IASP) pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (2).

For moment, highlight the emotional word in that last sentence. For chronic pain sufferers (chronic being as little or less than 3 weeks) it can be emotional and it is suffering- ranging from constant unpleasantness to the more debilitating suffering of pain. Loeser et al (2000) reminded his colleagues that despite incredible advances in science and its molecular detailing of the biology of pain the underpinnings all happen behind the eyes and inside the body of a patient, first and foremost a human being with consciousness. In addition, that pain is an emergent property of the human brain. Most poignantly, it is suffering that brings patients to the clinician, not pain.

…Start of a movement

In its simplest forms, it is dance, play of any dynamic kind, swinging an axe for wood, foraging and gathering, sex, walking to a destination, running through a forest, forms of active worship, picking up and rocking your toddler to sleep. In its more formal expressions we’ve formed communities around man-made activities- the colossal world of premiere monetised sports as the prime example and exercise centres. Sufficient qualitative evidence exists to show that ‘movement’ or exercise is an effective antidote for the plethora, if not all lifestyle and non-communicable diseases (ref). It is also about time that public perception was raised to the level of knowledge that the same is true for its analgesic effects on pain. In terms of public perceptions of chronic pain Moffett et al (2000) reported that nearly two thirds of a sample of 507 people in the UK believed that their pain was due to a slipped disc or trapped nerve. Most also expected to have X-rays and furthermore they found that more misconceptions of chronic pain were present in those who consulted the doctors about their pain which points to evidence of GPs giving inaccurate information or failing to correct their patients misconceptions about pain (ref). Despite it being a relatively older study it can be argued that misconceptions, attitudes and knowledge about pain have not improved in recent years with Hertzog et al(2016) reporting 10 different results from 10 MRI’s on one patient’s lumbar spine. This is astounding and demonstrates not only the problem of public perceptions and knowledge around pain but also clinicians errors, poor interpretation of results and assessments and hence poor management. It is therefore pertinent in my practice that we stay abreast of current research, that we are careful in disseminating information and advice to the patients, being mindful of persuasive, dominant language and that we invite the patient to be the main role-player in managing the process. We believe that various forms of movement are valuable tools that can be explored widely and safely. In combination with pain neuroscience education, empathic listening and a healthy therapeutic relationship we are confident that we can help make a positive change in the lives of those in pain.