How often do you say to yourself, “gee, I better book a counselling appointment for my back pain?” Our guess is probably never. And now you’re wondering how counselling could help with something like chronic lower back pain. Let me explain pain, and why counselling can be one of the most effective treatments for chronic pain (lasting 3-6 months or longer).
The very simplified version is that pain is an output from the brain to the body, not an input to the brain from the body. You can have a physical injury and be completely unaware of it, until your brain decides that it is worth registering as a threat to your safety and survival. Then you will experience pain. If the brain decides there is enough tissue damage that the area needs to be protected and given time to heal, it will register as pain. Once the area is healed, the pain should subside and regular movement and flexibility should be restored. Sometimes this requires some motor retraining which is what manual therapists like RMT’s, Chiropractors and Physiotherapists do. But, sometimes this doesn’t happen and even the manual therapy fails. So…..why?
Everyone has a pain threshold, which Mosely and Butler explain beautifully in their book Explain Pain. You can have low levels of tissue inflammation and irritation from small injuries or overuse that never trigger pain or discomfort because they are below your pain threshold. Most of us have experienced situations where we bent over to pick something up or reached for something and suddenly there’s intense pain and spasming in our back, neck or shoulders. This is a perfect example of having issues just under that pain threshold, that are pushed above the threshold by a seemingly minor incident, and now you really feel it. It's ”the straw that broke the camel's back.”
So what determines where a person’s pain threshold is? A lot of different things but one of the primary drivers is the balance between fear and safety, which is determined by your entire life’s experiences. Your experiences, relationships and education shape your beliefs about what is safe and what is a threat. For example, perhaps as a child you got going too fast on your bike, lost control, did an epic yard sale and broke your arm. Your brain is going to remember all of the details of that incident and use it to measure against future incidents to help you identify future threats and avoid injury. The interesting part is that it’s also going to remember the emotions attached to that incident. Was there a trusted parent there to care for you and make you feel safe right away? How were you cared for when you went for imaging and got your cast? Did you feel safe or was it very scary for you? Did you miss out on important activities during the healing phase? How was your pain managed? Did you receive the right medications to manage your pain? Studies have shown that inadequate pain management and emotional support in children can lead to a higher incidence of chronic pain and other health conditions later in life. Check out “When the Body Says No”, by Gabor Mate.
All of these things are now factors in how your brain assesses future threats to your safety and survival, therefore they are part of your pain threshold. Things other than physical injuries affect your pain threshold as well, including your past and present relationships, your experiences at school and work, your home life and upbringing, the homeostasis (balance of the systems) of your body, sleep habits, diet, hobbies, exercise and activities, etc. This is why the term biopsychosocial has become popular among practitioners who embrace pain science, because it encompasses an understanding that pain is complex and highly individualized.
Getting back to my point, explaining why counselling can be highly effective for chronic pain. If there was an injury, it was more than 3 months ago and the tissue damage has resolved. So why is there still pain? When pain becomes chronic, a few things are happening in the nervous system and brain. A number of factors have significantly lowered your pain threshold, so now your brain interprets many things to be a threat to your safety, even though they’re not and you're not consciously aware of the fear. For example, you take your dog for a walk around the neighbourhood and the next day you can hardly walk. These pain triggers can be things that are not even physical, such as social situations, relationship challenges or conflict, increased workload or anything that increases your stress. They may not even consciously register as stressful, but your nervous system is still registering a threat and reacts by producing pain. Unfortunately, it can become a cycle that feeds itself and gets out of control over time.
So how do we break that cycle? We’ve established that the issues in the tissues have long since healed, so it’s an issue in the nervous system that is really driving the pain cycle. I emphasize the nervous system here, because far too often this is miscommunicated as being “all in your head,” and you feel like you’re being told that you're crazy. You're not! But continuing to try to fix this with manual therapies, medications and exercises is just not going to cut it, in most cases. At the core is the low pain threshold which can be improved by stimulating neuroplastic changes in your brain with learning more about pain, understanding what’s happening in your body, practicing nervous system calming exercises like meditation and mindfulness, and talking through some of the things that contribute to your sense of fear and safety. It's important to work with someone who understands this connection to your pain, like a Registered Clinical Counsellor who specializes in pain management.
At Remedy Wellness Centre we have several Registered Clinical Counsellors who can help you get started on reducing or resolving your chronic pain. We offer free consultations so you can chat with any of them in advance and make sure it’s a good fit for you.
You can find out more about Registered Clinical Counselling at https://www.remedywellness.ca/counselling-psychology.html
We also have a Resources Page where you can learn more about pain science and many other interesting topics. https://www.remedywellness.ca/resources.html
Article written by Kasey Thompson, RMT. Pain Science enthusiast, educator and patient.
Sources:
Anand KJ, Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behavior? Biol Neonate. 2000;77:69–82. [PubMed] [Google Scholar]
Pain, The Brain and Your Amazing Protectometre: https://youtu.be/lCF1_Fs00nM
The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine https://pubmed.ncbi.nlm.nih.gov/11145816/
Explain Pain, Novel by Mosely and Butler
When the Body Says No, Novel by Gabor Mate