Chronic Pain: Bodywork Considerations

The following is a compilation of my notes from ABMP’s Webinar entitled “Body-Mind: Topic 5, Chronic Pain: Body-Mind Considerations for Hands-On Work” by Til Luchau

On pain… “We are often more frightened than hurt, and we suffer more from imagination than from reality.” ~Seneca, 4BC-AD65

*Back surgery and talk therapy can improve chronic pain the same amount.

*Pain is often perception: signal, sensation, opinion, emotion, illusion, punishment, motivator, reaction, feedback, protector

Mechanically caused sensation: “Tissue injury causes pain, in proportion to the amount of damage.” ~Rene Descartes, 1655

Spiritual: Pain is caused by malevolent spirits entering the body through an injury ~Aristotle (pain = “price paid” or “punishment”)

Tissue Damage Model: Acute pain has a clear cause. When we remove the cause, the effect goes away. The modern form of materialism is in play here: this is the doctrine that nothing exists except matter.

Pain & Brain: Pain is output of the brain, not of the tissues. The brain receives sensory input and then asks 2 questions:

  1. What does this mean? (context, location, memory, body position, etc.)
  2. What should be done? (feel pain; sympathetic, immune, and motor responses)

Pain is Useful: draws attention, motivates protective behavior change, promotes healing by increasing care

Pain is Emotion: “Pleasant/Unpleasant” Pain triggers activity in the midbrain, the limbic system (same as emotion). Pain also triggers the upper brain:

  • made worse by anxiety (non-specific fear of something that hasn’t happened)
  • made better by observation or learning

Body/mind Effects of Chronic Pain: depression, neuroticism, low self-esteem, anxiety, hypochondria, drug addiction, attention disorders, sleep disturbances, cognitive disturbances

“Invalidation”: People feel that their pain complaints are not taken seriously, that they are not believed.

“Pain is whatever the experiencing person says it is, existing whenever he says it does.” ~Margot McCaffrey, 1968

Touch for Healing: Normalizes sensations: increases the number of non-pain signals (pressure and movement is important)

Avoid Language:

  • slipped disc
  • bad leg
  • back is out
  • messed up
  • bone on bone
  • degenerated

Use Language:

  • sensation
  • sensitive
  • pressure
  • strong
  • hot
  • tight

“Kinesiophobia”: Fear of movement; Goal is to reduce the threat of pain, so use slow and subtle active movements

“We are often more frightened than hurt, and we suffer more from imagination than from reality.” ~Seneca, 4BC-AD65

*Redirect the focus of attention by asking, “Where do you hurt less?”

Pain Education:

  • increases pain threshold
  • decreases use of pain-killers
  • decreases pain-related stress
  • decreases perceived threat of pain
  • frees movements, which reduces pain

Considerations for Chronic Pain:

  • presence, persistence, patience
  • curiosity, compassion, comraderie
  • appreciate small gains
  • provide other resources (psychotherapy, pain management, educational materials, etc.)
  • Massage therapy is invaluable: human connection + empathy cannot be found in a drug


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