If you’ve ever experienced pain, you may find yourself asking one of the following questions:
What is wrong with me?
How long will it take me to feel better?
What can I do as the patient?
How can a healthcare professional help me?
Pain often entails justified levels of concern.
The Toughest Question: What Is Wrong With Me?
The toughest question to answer is usually the first one. We all have preconceived notions about what is going on, and this may stem from a wide variety of sources and previous experiences.
Ask yourself: What do I think is going on, and where do these beliefs come from? Often, our answer to this question comes from our previous experiences and the experiences of those around us. This is what we call making sense of our situation. Unfortunately, not all information that we have is helpful to our situation.
Compare the Pair
Compare two people:
The first person experiences a bout of lower back pain a day after their rugby league grand final, despite not experiencing any pain during the game. Notably, this person has been experiencing back pain for the entirety of their season, with regular increases in pain following intense games. In their experience, the back pain usually subsides within a few days. They’ve been in a cycle of slight increases in pain following these games, and as a result, the pain experienced in the days after the grand final involves minimal concern.
The second person experiences lower back pain for the first time in their life. They work in the construction industry. Their father and grandfather had to retire at early ages due to debilitating back pain. Although nothing sinister happened or is suspected, concern is incredibly high for what this current bout of lower back pain means for them and how it may affect their future. Will they need to retire early too? How will they be able to financially support their family?
In these two cases, it is important to recognise the differences in experiences these two people face, despite having the same symptoms. How might the information available to them influence their current beliefs and behaviours moving forward? How might their behaviours further influence their pain?
This blog post summarises a research paper exploring the relationship between fear and musculoskeletal pain, offering insights into how fear can impact your pain experience and providing strategies to promote recovery.
Pain as a Protective Mechanism
Pain functions as a protective mechanism, alerting us to potential danger and promoting healing. Although we experience pain in conjunction with tissue damage or injury, we can also experience pain without any damage or injury, particularly with pain that lasts a long time.
If we only experienced pain once we hurt ourselves, we’d likely be hurting ourselves much more often, and an important function of pain would be obsolete.
So how can we differentiate between when pain means damage and when it does not? How would we know if it’s safe to continue with regular activity or if we’d be making our situation worse?
How we make sense of our pain shapes our cognitive, emotional, and behavioural responses. If your body perceives pain as threatening and you feel a lack of control over it, it can become distressing, self-perpetuating, and disabling.
Fortunately, the longer that pain persists, the less reliable it is as an indicator of damage. Things that never used to hurt may start to hurt, even though they are far from causing damage. This includes things like cold weather or a simple massage to the area.
This can be empowering to consider when experiencing pain in the journey of recovery. In cases of long-term pain, it’s likely that pain serves a different role and does not indicate damage. Rather, its primary function is as a protective mechanism.
Experiencing exacerbations of pain does not mean we are causing more damage or making our situation worse. The idea that an increase in pain equals an increase in damage is not always accurate—damage may never actually be present. Over time, pain can change and decrease its sensitivity to various stimuli.
The Fear-Avoidance Cycle
When pain means damage or vulnerability, it can trigger fear and avoidance behaviours. These behaviours can be influenced by societal beliefs and information from healthcare professionals.
Unfortunately, common societal beliefs often emphasise the fragility of the body, reinforcing a negative perception of pain even in the absence of serious pathology.
This response is a natural reaction to perceived danger. While avoiding activities may initially reduce pain and fear, it prevents you from having positive experiences that could challenge your negative beliefs.
This avoidance can lead to a vicious cycle of fear, reduced activity, and increased disability. If you want to reduce fear or return to activity, at some point, you’ll need to engage with it.
The body is anti-fragile—it improves with the stresses and loads placed upon it.
Promoting Safety Learning
The key to breaking the fear-avoidance cycle lies in safety learning. This involves gradually exposing yourself to feared activities in a controlled and safe environment, allowing you to experience that these activities do not cause harm or worsen your pain.
These exposure-based approaches (Cognitive Functional Therapy – CFT) can be led by a:
Physical therapist
Physiotherapist
Exercise physiologist
Other healthcare professionals who focus on understanding your unique pain experiences
The CFT Approach
1. Therapeutic Relationship
A trusting and supportive relationship with your therapist is crucial for safety learning. Open communication, validation of your experiences, and a shared understanding of your goals are essential.
2. Exposure with Control
This involves gradually engaging in feared movements and activities while challenging unhelpful cognitions and behaviours. Your therapist will help you:
Modify your movements
Reduce protective behaviours
Focus on relaxation techniques to create a positive and safe experience
3. Making Sense of Pain
Through self-reflection, guided by your therapist, you can develop a new understanding of your pain—one that is less threatening and more empowering.
The Journey to Recovery
The journey to recovery is unique and personal. It requires patience, persistence, and a willingness to challenge your fears.
Remember, setbacks and pain flare-ups are normal. Often, the most learning occurs during these periods, as they allow us to implement and reinforce a different view of pain—one that highlights its protective function rather than an indicator of damage.
CFT provides tools and strategies to manage these challenges and regain control over your pain experience.
Conclusion
The role of safety learning is crucial in overcoming pain-related fear and promoting recovery.
Cognitive Functional Therapy (CFT) offers a promising framework for achieving this, empowering individuals to regain control over their lives and pursue their valued activities.
Ready to take the next step in your recovery journey? At Move 2 Thrive Clinic, our expert Exercise Physiologists are here to support you with evidence-based strategies like Cognitive Functional Therapy (CFT) to help you move confidently and without fear.
📅 Book your consultation today and start reclaiming your active lifestyle!
📍 Located in Minchinbury, Western Sydney
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