Your Beliefs about Pain
Understanding Pain requires learning new concepts. If you already hold inaccurate beliefs about the pain, we need to undo these first. This may put you in conflict with your pre-existing (less accurate) knowledge and fight against accepting new (hopefully more accurate) information.
It is common for people with chronic or persistent pain to have faulty ideas about how the body works and what is causing the symtpoms. While we still have a lot to learn about pain, we refer to these as misconceptions.
Faulty ideas are held at various levels indicating both how strongly you hold the knowledge and how challenging it will be to change.
Pain Belief Category 1
Missing bits – You have a reasonably accurate concept but are missing a few key pieces of information. I will use education to fill those gaps with better information.
Eg: if you worry you “have a bursa” in your painful knee, you may believe it is a cyst or foreign object that shouldn’t be there. But, bursae are a natural part of our anatomy with a useful protective/cushioning/friction reducing role. If the bursa is inflamed it may send you a “danger” signal that it needs treatment. As a physiotherapist, I can clarify this thought and help treat your problem.
Pain Belief Category 2
Single grain misconceptions -You have a single concept of what is wrong but you are flexible about accepting new more accurate information.
Eg: “It’s old age” or “my back is out”.
We tackle this thought head-on with an accurate diagnosis and explanation.
Age is not what is causing you to hurt as age isn’t a pathology! If it was an age problem wouldn’t your left knee hurt just as much as your right knee,”
Pain Belief Category 3
Sandcastle level misconceptions – you hold these deeply as multiple concepts linking up to form an elaborate knowledge structure.
Eg: “I have pain, therefore, I am damaged”,
“It’s not safe for me to move, bend or exercise while my back hurts.”
“Every time I move I can feel it grinding, it cracks if I stretch, once you’ve hurt your back it’s never the same again, my x-ray shows severe degeneration, I was told I have an up-slipped pelvis”
We can change these misconceptions by replacing the whole sandcastle at once or bit by bit. Both ways take skill, deep knowledge and time.
The book, “Explain Pain” is a holistic confrontation – replacing misconceptions with new and more accurate information about pain, the brain and the body.
Sandstone Level Misconceptions
Eg: “My suffering is God’s will”
“It’s a massive disc herniation – four surgeons have told me that if I don’t have surgery I will end up in a wheelchair – even I can see it on the MRI”
“Nobody can help me”
These mental models may be based on culture, religion or long-term biomedical exposure. Physiotherapists try to educate from within your concepts without directly challenging it. We chisel and chip away at the faulty beliefs.
My aim during a consultation is to listening carefully, question you further, and develop a strong therapeutic relationship to maximise the benefit for you.
Adapted from Dr David Butler Explain Pain, by Helen Potter FACP 16/02/18
Please contact Helen to discuss any aspects of the information on pain viruses and faulty thought beliefs.