Different Approaches to Pain

Recently I have worked with two clients with starkly different responses to past experiences of physical trauma and pain which had greatly affected how they were living in their bodies now. I have been thinking for a while what is the purpose of pain and whether there is a space for embracing pain for longer term benefit?

This cognitive aspect of pain can modulate the affective-motivational components of pain which can be referred to as cognitive modulations, some examples of this are placebo, nocebo, CBT and neuro-imaging. The idea that our experience of pain can be modulated by our thoughts and associations is something that I will I return to.

I would also like to draw a comparison in this article between how we use the word 'pain' in relation to sensations experienced during massage, to how the word 'failure' is reflected upon in the creative process. Art and bodywork are two fields of experience in my life from which I draw many parallel lessons. I will reflect upon how the word 'pain' like the word 'failure' can be placed within a context and how we can reevaluate it as positive and enabling as well as negative and crippling.

Reflections 1

I will start with the example of a client I worked with for several months over the summer. This client had suffered a cruciate ligament injury whilst playing sport 18 months before, and when I met him had just completed a period of physio. He had adapted his training and outlook quite considerably since the accident and was very open minded in his approach. For him the key was to develop his body awareness to prevent further damage if possible. He described the pain in his knee as being the worse he had ever experienced and the recovery process as lengthy. He never wanted to experience this again. This sensory experience had stopped him in his tracks and forced him to reevaluate his approach to his body. This sudden physical 'failure' of his body and the associated pain became a measure by which all other pain, discomfort and sensation could be gauged. It revealed to him the need to adapt his habits.

Pain is of course initially a protective measure for the body and therefore a very important and useful threshold for the body to register. The body adapts it's structure to compensate for the injury. However, this response is only useful for a period of time. Once the injury has healed, with or without an operation the associated pain is a shadowy memory of the place of trauma, which the mind can keep present through habit. Having fixated for some time on a body part to protect it, it can become isolated from the whole. Like a knot in the rope it can restrict movement and cause tensions elsewhere leading to imbalance and rigidity which can become negative to overall healing. To experience the benefits of pain we need to escape from the myopic focus and experience the whole.

My first client was very open to new experiences. He did not want to let his trauma limit him. He was willing to change his approach to the things he loved doing in order that he could keep doing them. He worked with his body, taking up new activities such as yoga and with it a new mindfulness. Massage for him was a continuation and deepening of this process. The pain he felt in tired and achy muscles was easily put into perspective against the memory of his knee and he started to recognise that this could be classed as something different, a 'good' pain that helped him recognise when he was holding tension and a way of mapping the patterns of tension that occurred.

Through massage he was able to engage with his body in a positive and sensitive way. Over time he even asked me to work on his affected knee which he had initially felt apprehensive about. He recognised how he tensed his hip at first touch, but over time this also released and he thanked me for helping him accept the knee and forget its difference. He no longer fixated on this one area, through massage he could re-integrate the body part with the whole body structure and feel connected.

Reflections 2

My second client responded to pain in a very different way. Having broken her leg four years before she had developed a greater level of caution in her movements and in her approach towards the activities she engaged in. This distrust of her body manifested on the massage table as a high level of tension throughout her back, shoulders and hips. As I placed my hands on her body she was nervous and talkative, holding her limbs in closely to her torso. We worked gently and slowly, it was not possible to work at any real depth as this would have been counterproductive. The caution she had developed towards her body limited her response to massage and I had a feeling that this could also been true of her life as a whole. I sympathise with this habit of caution as it is in my nature too. I have always feared failing and felt that being in control was the only way to avoid its jarring impact and yet it is when I have stepped into the unknown for example from the world to art to that of bodywork that I have really started to feel a sense of possibility. It is challenging and unnerving at times, sometimes even painful, but ultimately I believe it has been worth the risk. With people like myself and my 2nd client a longer programme of massage is even more important as it may be the first and vital step to a process of discovery and recovery. However, this has to be a journey one is willing to explore and commit to, along with its twists and turns. Sometimes the moment we open up is also the moment we feel most vulnerable.

To conclude, it may be controversial but in this cognitive context I think we can start to see pain as something of interest in our bodies, something dynamic and changing, that punctuates life and gives it tone. A guide to wellness as well as unwellness, as without it's darkness we would have no concept of light. Pain in the context of massage i.e. 'Good Pain' is the body's feedback system. Awakening our awareness of deeper tension within the body. We can learn from this kind of pain the importance of the whole as we become more adept at following the clues that such sensations reveal to us, in a safe context and guided by a qualified body worker.

In this vein failure in the creative process is a useful tool. If we only focus on the end of the journey we often find ourselves stuck, whereas if we take interest in the process, the pitfalls and necessary changes of direction we reach a more interesting and ultimately more sustainable (successful) outcome. There is never an endpoint to be achieved but simply a process to be present within, with points of reflection along the way. Failed projects are as valuable to reflect upon as successes as they provide an element of challenge which fuels creativity. Failure is of course also only a word, and a learnt behaviour. When a small child falls they look to their parents for guidance, if the reaction is negative, they learn fear and cry, if their efforts are encouraged they get up and try again. They experience their small 'failure' in a safe space and it just becomes part of the game of self discovery and learning. As a massage therapist I aim to create a safe space for the client to experience/ witness their body and to engage with a process of enquiry and development.

The artwork included in this article was produced by Thea Willcocks.