Explaining Chronic Pain:
Key to the Posters
People in pain frequently become involved
in a complex system. The poster illustrates this system which includes:
work (co-workers, supervisor, management, union); treatment and
investigations (doctors, physiotherapist, psychologist, occupational
chiropractor, naturopath, pain clinic...); and compensation and
litigation (insurance company, solicitor, conciliator...). Unfortunately
of the system frequently have competing agendas and the power struggles
which result leads to chaos. Loss of control and powerlessness
can be experienced by all members. The person in pain looks to
for support, comfort, explanations and solutions but may experience
the opposite: hostility, disappointment, criticism and disbelief.
The question “Who is helping?” needs to be asked.
No Responsibility Model
Pie charts illustrate the typical response to injury in the workplace:
light duties, investigations and treatment OR rest, investigations
and treatment. The injured worker is not invited to take responsibility
for recovery and thus the system creates VICTIMS.
Shared Responsibility Model
In this model the injured worker takes at least 50% of the responsibility
for recovery through developing self-management techniques.
This model attempts to explain the puzzle of chronic pain. Simple
falls and minor car accidents can result in chronic debilitating
pain syndromes. Investigations do not reveal tissue damage which
can explain the severity and widespread nature of the pain instead
we need to look at a more complex explanation incorporating physical,
psychological and social factors as contributors to the syndrome.
The injury itself can be a result of physical stressors (car accident,
lifting injury, over-use injury) but these often occur in the context
of emotional stress (conflict, time urgency, perfectionism, excessive
demands). Indeed emotional stress alone may cause pain. Pain is
experienced by a person not just a body and the person reacts to
the pain according
to what they are told, their past experiences, the meaning of the
pain and the treatment they are given. Unfortunately, a cycle of
negative thoughts and feelings can develop which leads to a pain
sensitisation state (pressure and movement, previously not painful,
become painful). The body then reacts to this pain sensitisation
with muscle tension, postural changes, guarding and restricted
movement. The person in pain becomes inactive and unfit which leads
pain and the cycle is complete. Once the cycle has begun
it continues independent of the injury.
As well as the person’s reactions,
pain causes reflex muscle spasm and some pain sensitisation occurs
simply from having chronic pain. There are important consequences
of the model: physical treatment, alone, fails; psychological treatment,
alone, fails; passive treatment, alone, fails; beliefs become reality;
and self-management is essential.
People react to pain in ways which can
actually amplify their pain. Learning to change a reaction (automatic)
into a response (conscious
choice) can transform a person’s experience of their pain.
The characters on the poster depict the different attitudes people
have to their pain. Avoidance, resistance, helplessness and hopelessness
tend to open the pain gate or amplify
the pain. Acceptance, curiosity, courage and patience tend to close
the pain gate and reduce the pain.
If a person becomes aware of the ways they react to pain they can
then make a choice about ways they could respond instead. The poster
demonstrates how reactions (reaching for pain killers, rushing
to the doctor or physio) can be replaced by actions (relaxing,
gently...). Similarly, reactive thoughts (I’ll never get better,
I can’t stand it...) can be replaced by responses (It’s
temporary, I can handle it...). The poster emphasizes the importance
of a person’s relationship to their pain. When a reaction
is turned into a response pain relief will follow. As the pain
less bothersome more activities become possible and life becomes
This poster depicts the self-manager who says:
“ I am in control, I am organised,
I can heal myself.”
The self-manager holds a clipboard to represent organisation and
a wand to represent the inner healer or potential for self-healing.
The four aspects of the self-management
Attitude permeates the whole program, attitudes to relaxation,
exercise, occupation, pain, disability, and the system, determine
the program becomes. Learning to live in the present is a way of
letting go of emotional baggage which keeps the person trapped.
A pessimist can become an optimist when the opportunity for self-development
take the tension out of life and learning to “let
go and go with the flow” leads to inner peace. Muscle relaxation,
breathing techniques, visualisation and meditation can all provide
release and relief. It is the daily practice (10-20 minutes or
more) which produces results.
Exercise is a way of moving out of pain. Learning to move with
awareness takes the person beyond the obstacle of exercise causing
exercise (5-6 times weekly) and SSS (stretching, strengthening
and stabilising) daily, are an essential part of the path out of
Occupation can provide a reason to get well. Feelings of self-worth
are restored as the self-manager finds direction, meaning and purpose