"My pain is not your pain, and your pain is not my pain.” Those are the words that stuck to me when I first heard it from Dr. Andriaan Louw’s lecture on “Teaching People about Pain” in Medbridge education. I was undergoing an awful bout of subacute pain that week which lead me to Dr. Louw’s course.
It has already been two weeks since my pain began. It started when I went for a hike in one of the nearby trails here in our county. It was about a 4.2-mile trail which consists of mostly ascending path towards a 360-degree view at the summit.
Right then, I knew that I would be sore for the coming days. Hiking in incline and decline surfaces forces your muscles to contract eccentrically more than you normally do in walking in a flat path. So, I knew my back and legs were in for a treat.
During the week after the hike, I was experiencing the normal feeling of muscle soreness and pain. It was difficult to negotiate stairs, sit down or stand up from a chair, and of course bending the trunk forward. I was a mess. But I expected it, I knew it would happen.
The soreness on my left leg significantly decreased by day 3, but the pain and soreness on my right leg lasted longer. I knew this well too because I have a history of sciatic pain on my right which I got over with physical therapy more than 10years ago. But somehow, that hike triggered it again.
During the second week, I was in a different and worst type of pain. My pain now became sharp and more frequent, radiating from the back of my right thigh to the back of my right leg. I had trouble staying in one position for a long time. Sometimes the pain goes away with walking or sitting, sometimes not. I figured, I should try to perform exercises and stretches for sciatica again. After all, I’m a physical therapist, I had this before. I should be able to treat myself.
I performed a lot of flexion exercises – piriformis stretch, hamstrings stretch, knee to chest and double knee to chest stretches. It provided temporary relief and so I thought my intervention was working. But I was wrong. My symptoms were just getting worse. I started to experience nagging, dull, and burning sensations on the painful areas.
Starting the third week, I realized that needed to understand the pain first before I can address it. In what positions is the pain worse or better – standing or sitting? What movements or activities relieved or aggravated it? What sleep position do I feel better waking up – prone, side lying, supine? These were the question I failed to ask myself when the pain started. I knew that peripheralization (radiating to the extremity) of pain is bad, so I had to find ways to centralize the pain.
I was researching on low back pain interventions and pain science. That’s what lead me to the quote above from Dr. Adriaan Louw’s course. He mentioned in the lecture that pain is affected by a person’s values, behavior, attitude, and education. How a person perceives pain and how they deal with it depends on their past experiences and their present belief system.
There were times I wanted to go the hospital because of excruciating burning pain on my leg. I feared that I may have herniated a disc or something. But then again, I know that research said disc herniation heals itself over time. I also know that promoting and repeated movement towards the direction of no pain will help treat the pain.
And then that dawned on me. What if I wasn’t a physical therapist? What if I didn’t know what I know? Would I call 911? Would I lay in bed 24/7 until the pain goes away? Will I pop in pain medications to help with the pain? I did neither of that. I didn’t call 911. I continued to work as best as I could, limping and all. I didn’t even take pain medications. I knew I had to understand my pain. I knew that giving in to pain is more detrimental than facing it. Dr. Louw shared a quote that Gordon Waddell popularized, the fear of pain is worse than pain itself. I agree. I didn’t want to develop any fear avoidance behavior. I didn’t want to give in to the pain. I knew better.
I learned that I wake up with less pain when I lay in prone with a pillow under my torso. I knew that it hurt at first getting into that position before it starts getting better. So, what if as soon as I felt my back hurt, I gave up on that position? Would I even know that extension and prone was my bias? Often, when I ask my patient lay in prone, they would say it hurt them. I didn’t even bother to ask them to hold the position for a while and see what happens. I was unknowingly perpetuating their fear of pain.
I, like many patients have sometimes fallen into the false belief that by doing the positions and the exercises for only a couple of times, that the pain would magically and instantly disappear and anything that hurt should be unconditionally avoided. We forget to emphasize that rehabilitation is a process and that like any training regimen, there are challenges and hardships before we see the result and we should stick to the program and be consistent with our actions. Plus, the belief the program works would really help.
After those 3 grueling weeks of pain, I was able to come out of it stronger and wiser. I don’t have that burning, aching, sharp radiating pain anymore on my right lower extremity. The pain has centralized and only comes out when I am sitting for a long time in an awkward position. I feel better.
Would my back heal itself if just endured it and waited it? Possibly. Would I have enjoyed life while enduring the pain? Absolutely, not. I was miserable in the inside. Would I know now what to do next time it happens again? Certainly.
So, here’s what I want you to take away from my experience.
- People approach pain differently. Two people experiencing the same incident may perceive and handle it differently. As physical therapists, we should be able to understand why patients perceive pain like they do. And try to validate their feelings and dig deep to understand their pain.
- Education is key to changing one’s beliefs, attitudes and values towards pain and rehabilitation. Empower patients in taking hold of their health and letting go of their fear of pain.
- And lastly, we should instill in our patients the idea of “training” in the rehab process. As a training process, it involves hard work, perseverance, commitment, and consistency with the program. Our interventions in physical therapy is not a pill they take once and that’s it. It’s more like a maintenance drug that they must take repeatedly and regularly for it to work.
