It’s all in your head, that’s ok or maybe not? Reprise

“So I’m just going to come out and say it, please don’t be offended: Two physios that you know have suggested that you ignore the tissues and say that pain is all in your head” said the podiatrist.

A podiatry colleague and I were having a conversation about establishing some teaching workshops. I detected some apprehension, and after his comment things seemed to slow down for a moment whilst my natural defensive instinct kicked in. My partner once said to me that “The mind creates thoughts like the body secretes enzymes”, and I experienced this while I had a moment that felt like Neo in Matrix Revolutions. He meets the architect of the matrix in a room of television screens, and at one point the screens begin to show Neo displaying every possible emotion Neo could have in response to a comment by the architect, but outwardly Neo himself stays calm and relaxed.

Now I could have reeled off all about the transmission and propagation of nociception from tissues to spinal cord, and discuss the challenges between understanding the relationship between nociception and pain, but what would that have proven? Not a lot, in my honest opinion, and it just would have made me sound like a douche! Instead, I managed to remain calm and requested that he ask the physiotherapists to contact me to discuss their concerns about my interpretation of pain as an output of the brain. If I’m sending out the wrong message, I want to learn from others on how I can improve my delivery.  I am yet to hear from them, however I wanted to share a short reflection.

Interpretation is a fine line to walk. We will always have our own confirmation biases influencing our interpretation of someone else’s message. Trying to get a particular message out without some kind of pushback is difficult.

There are many outcomes that can come from interpretation; feeling threatened, defensiveness, agreement, competitiveness, collaboration. I think the questions to ask ourselves are ‘Does this person’s beliefs match my beliefs?’ ‘Do my beliefs influence my practice? Do I use critical thinking to minimise the effects of my biases? Am I up to date with the science?’  It’s all good and well knowing the science but it’s a whole different ball game interpreting it.  That’s a blog for another time.

I think what is important is that one individual’s understanding of pain science over another can give a false sense of everyone thinking about pain differently. An excellent paper by Barker et al (2009) highlights this perfectly. They identify a number of issues that arise resulting in a division by a lack of common language:

‘Patients and professionals appear to define terms differently leading to misunderstandings when both think they are talking on common ground by using particular jargon. Furthermore, misunderstandings among health professionals concerning terminology can arise. Multiple back pain classification systems and terms exist and many health professionals use medical terms in various ways reflecting habit, experience, personal views and professional background. This can hinder effective communication between professionals.’

This is further supported by Stewart (2015) who highlights the challenges for clinicians and patients in understanding pain and translating the complex theories of the biopsychosocial model to the clinical front line.

It’s important to question appropriately through use of guided discovery and to be honest and upfront when explaining concepts of pain and the brain if they are even necessary (see  blog post here). To highlight that there are biological adaptations going on all the time.

I will wait in anticipation for the two physiotherapists to contact me to discuss their concerns.  I accept that my delivery could be something that I need to work on, however, it is also important to consider that it is subject to misinterpretation, lack of understanding of pain neuroscience, threats to livelihoods, confirmation biases (the list can go on and on). Or perhaps they are attempting to administer their clinical clout, we shall wait and see!

Thanks for having a read

TNP

References:

Barker, K. L., Reid, M., & Minns Lowe, C. J. (2009). Divided by a lack of common language? A qualitative study exploring the use of language by health professionals treating back pain. BMC Musculoskeletal Disorders, 10, 123. http://doi.org/10.1186/1471-2474-10-123

Stewart, M. (2015). The assumption dilemma : do healthcare professionals have the teaching skills to meet the demands of therapeutic neuroscience education ?, 13(1), 40–42.