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7May

Specialist Pain Physiotherapist

Not that I am calling anyone an ‘old dog’, ’you can’t teach an old dog new tricks’  is a universally understood phrase implying that once we are set in our ways, change is impossible. This is simply not the case. I am referring to our ability to change our views, beliefs, behaviours and experience of life. Our brains are not, as previously thought, hard-wired. Behaviours, actions and activities that we ‘choose’, are based upon our belief system that are created and moulded by life experience. I say ‘choose’ as there is a debate as to whether we really have free will or not that is rather interesting. As we go through life, there is a huge amount of learning that is continuous and fundamental to our development and very existence. Pain is also part of our learning experience: you soon learn that it is hot to touch an oven when it is turned on.

We can learn all sorts of skills. We can develop and master these skills with practice in the case of playing a musical instrument or becoming a great sportsmen or sportswomen. This takes dedication and rehearsal, and as we improve our brain is changing. In fact, the brain is changing all the time. I frequently say to patients that both our brains have changed within this session from our conversation. We take on board new information and place this into our existing belief about ourselves and the World. It may make sense and we take it on board and adapt or we may see the new information as being too challenging or as holding no value, although this may change at a later date.

The brain changes, we can change

In terms of pain and in particular chronic pain, the brain and body has adapted to continue to protect itself and often vehemently in the face of a perceived threat. This is conditioning and learning. During this time we can also construct a set of beliefs that can be defensive: ‘I’d better not move as it hurts and this means I am damaging myself’. The reality is that in most cases of on-going pain, the problem lies not so much in the tissues, although they can be unfit, tight, boggy and inflamed, but in other body systems such as the nervous and immune systems. This statement alone is challenging and requires qualification in the clinic with high quality education and positive experiences if it is to be absorbed and taken on at a deeper level. Even when we take the message to heart we can slip at times, similar to the smoker who stops until a certain set of circumstances arise. The message then needs re-evaluation and re-integration. In pain we now talk about the messages of ‘pain from the brain’ (not the mind) and ‘hurt but not harm’. These too are challenging statements and thoughts but based upon current science.

So, we know that the brain creates the experience of pain as an ‘output’ in response to ‘input’ that can include danger signals from the tissues, thoughts, past experiences, genetic factors, emotional state and stress for example – see Lorimer Moseley talk about this here. To treat pain therefore, we must target the brain to a greater or lesser extent depending upon the circumstances – perhaps more tissue based in acute cases although I fundamentally believe that some form of tissue-based treatment is important in all cases including chronic pain – this for another discussion. The brain is plastic, meaning that we can mould and manipulate the structure and function of this incredible organ with the right stimulation. We also know about changes in the actual size of certain areas of the brain in pain (prefrontal cortex) and with learning (hippocampus).  

Taking this on-board, we can design and implement treatments and strategies that conceptualise pain in its most modern sense and really tackle the ‘at source’ mechanisms and issues for improved perfomance and better living. Considering pain within a conditioning and learning paradigm, understanding that nerves that ‘fire together, wire together’ and that pain is one of the responses to danger amongst a number of other contemporary, science-based concepts, means that we are becoming increasingly effective in dealing with this significant and costly problem. We can then, teach an old dog new tricks by thinking the right way about pain and using treatment that promotes tissue health and movement that is only as good as the brain that controls it.

  

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