Safety in Pain
Feeling safe makes a huge difference to recovery from pain.
Bill, a 72-year-old, semi-retired professional walked into my spine clinic office last week as a new patient, with slight progression of his long-standing, achy, low back pain stating, “I’m afraid I’m going to be crippled or paralyzed.” No red flags — or signs of obvious danger. No severe physical distress or emotional lability — he didn’t strike me as crazy. His MRI showed some active wear-and-tear happening in the inside of a mild scoliosis without significant narrowing around the nerves. And his exam was likewise reassuring — nothing alarming clinically. Pretty much what you’d expect for an average man of his maturity.
We now know that the tendency to “catastrophize” is a predictor for persistent pain — lasting longer than is helpful, so I wanted to understand where that level of fear was coming from. He shared that the language in the MRI report sounded like his spine was crumbling. Half my time in clinic is generally spent undoing the unnecessary tripping of the patient’s alarm system by having read their MRI reports, and the way I do that is by reassuring them about age-appropriate findings. You see, radiologists aren’t talking to patients, so they use medicalese — words like “degenerative, broad-based disc bulge” or “annual tear” or “neuroforaminal stenosis” and now that they are accessing their records, patients naturally fear what they can’t understand.
I further shared with him that the Neuroscience of Pain now shows conclusively that all pain is produced by the pre-conscious threat detection system in the brain, warning the stripe of conscious brain that is aware of our body parts when (and this is important), credible evidence of danger to the body outweighs the credible evidence of safety.
Pain is always real, but also always an output of the threat detection system. Was Bill safe as he walked into my exam room? Did he feel safe? The takeaway point for Bill was that pain isn’t a very reliable indicator of how much danger we are in.
His pain reduced significantly from education about pain, reassurance about his MRI, and ultimately from how he was able to respond to his pain. The term for this is “Therapeutic Neuroscience Education,” and Bill’s response is consistent with what research shows — that learning about Pain Science actually reduces threat which reduces pain.
As I reflect on the numerous patients like Bill that enter our care, I’m captivated by the promise of a different story about pain. I know how it affects patient experience, clinical outcome, cost of healthcare and patient safety, because this is a conversation I have every single day.