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Pain Narratives, Part 1. Who Shapes Our Pain Stories?

Recurring pain can put us in a state of hopelessness, frustration, and fear. Chronic pain alters the relationships we have with our lives, our emotive states, even ourselves. It makes sense that the lens in which we view our pain might naturally be framed in both resistance and denial, and also in hopelessness and acquiescence. This shapes the language we use when relating our pain.

So often when I am talking with people about their pain, whether in a therapeutic context or a conversation with a friend, I notice the language used to describe pain tends to be influenced by diagnoses or medical consultations. The language tends to be graphic and set within metaphors and comparisons to trauma, with a bit of an overtone that accepts as truth the information given by the doctor/chiropractor/physical therapist/massage therapist, etc.

I almost always hear that the person has experienced a medical or therapeutic professional describing what is potentially going on in their body with jolting, catastrophic language and metaphors, which the patient then absorbs as their lived experience. We trust the people we turn to for help and advice. The information and descriptions given by those we seek for help we tend to take as factual, because in the fog of chronic pain, an answer of any kind might mean a treatment for relief.

Here are a few examples from my practice and my personal life. Note the language used.

  • A client I see who has chronic neck pain told me she can’t recall any physical trauma to her body that would cause her neck pain. It organically began to flare up when she is overwhelmed or sometimes when she goes on runs. She religiously saw a chiropractor for several years who had told her, “You might as well have been in a couple car accidents and suffered severe trauma because your neck is unbelievably damaged to the point of no return to normalcy.” She told me this as she gripped the back of her neck and grimaced.

  • A friend in his late twenties exasperatingly described his chronic back pain with his doctor’s words, “Your body is wearing away like a 50-year-olds would. Your sacroiliac (SI) joint is extremely unstable. I wouldn’t be surprised if you will need surgery at a young age.”

  • Another client tells me of a massage therapist who told her that her back pain is caused by her “twisted pelvis” and that regular massages would “untwist the pelvis temporarily, but probably not cure it”, so a lifetime of regular treatment should be expected.

  • My own experience with chronic shoulder pain led me to a physical therapist who said my body “doesn’t understand how to function normally, and a lifetime of existing as it does has caused my shoulder to give up.” I also had a chiropractor tell me that I had worsening scoliosis (news to me, and I have never experienced any sort of pain from this).

This is wild to me. Does graphic information that sometimes sounds shaming to the pain sufferer do any good? What kind of imagery does a “twisted pelvis” or a “severe car accident neck” implant into the mind? How can hearing words like these influence our own perception, and ownership, of our pain?

In my personal experiences, I did question the information given to me. I felt that the words used about my body were insensitive and assumed as factual by the practitioner. My lived knowledge of my body did not align with the practitioner’s messages, yet my voice felt unheard compared to the standard diagnoses and treatment options suggested.

As I began practicing massage therapy, I listened to the pain narratives of clients. Their stories always began with “my doctor (or other professional) said…” and went on to tell me not so much about their own felt experiences with their bodies, but the graphic and negative descriptions from a medical perspective. These descriptions they sometimes relayed like a badge, like a battle wound in their awful reality defined by experts.

This led me to consider the modern pain science I had researched in the desperation to understand my own pain. Current studies of the past 5-10 years have reflected evidence-based, more hopeful approaches to chronic pain management that consider the role of the nervous system in interpreting pain signals, and how the states of our mind can influence our experience and response to pain. There are emerging and more accepted models of how our thinking and our bodies make an interconnected system.

In the context of massage therapy, where so many clients see me using language in their narratives that is influenced by someone else’s diagnoses or professional opinion, integrating neuroscience models of chronic pain management has become so important to me. In the case of chronic pain sufferers, what has been found is that there may not be a current major physical trauma to the tissues in the body that is creating pain. Pain triggered by tissue damage is called nociceptive pain. Sometimes, it may be the nervous system itself that is misinterpreting otherwise normal signals as dangerous - triggering the sensation of pain. This is called neuropathic pain. It can arise from previous tissue injury or from an unspecific circumstance. It is complex and just as real as nociceptive pain, yet it is built around the patterns of our brains and the behavior of our nervous systems. Therefore, addressing recurring pain, which may be neuropathic and not nociceptive in many chronic pain sufferers, requires a multi-angular approach beyond the physical aspects of therapies.

(pictured above: neuron art)


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